Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 10859 | KS |
NPI | 1003240375 |
---|---|
Provider Name | Elizabeth R Wehlage |
First Address | Pittsburg, KS 66762-2546 |
Second Address | Iola, KS 66749-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2013 |
Last Update Date | 22/08/2013 |