Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5236015 | WI |
NPI | 1013923911 |
---|---|
Provider Name | Jaime K Marchi |
First Address | Sheboygan, WI 53081-3041 |
Second Address | Sheboygan, WI 53081-3041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33762400 | (05) | WI |