Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1002426 | WI |
NPI | 1003421272 |
---|---|
Provider Name | Dr. Peter James Nebel |
First Address | Minocqua, WI 54548-8722 |
Second Address | Lac Du Flambeau, WI 54538-9386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |