Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 5451-16 | WI |
NPI | 1013556547 |
---|---|
Provider Name | Jeannie Ledwitch |
First Address | Pleasant Prairie, WI 53158-3926 |
Second Address | Mount Pleasant, WI 53406-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2020 |
Last Update Date | 01/01/2020 |