Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1002490-16 | WI |
NPI | 1043693187 |
---|---|
Provider Name | Jennifer Strauss |
First Address | Oconomowoc, WI 53066-3756 |
Second Address | Oconomowoc, WI 53066-3756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 07/07/2015 |