Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019.031723 | IL |
N | 122400000X | Denturist | 019.031723 | IL |
NPI | 1982192316 |
---|---|
Provider Name | Dr. Nicole Marie Kujawa |
First Address | Milwaukee, WI 53233-2186 |
Second Address | Milwaukee, WI 53233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2018 |
Last Update Date | 04/01/2019 |