Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | A12760 | MN |
NPI | 1376798173 |
---|---|
Provider Name | Jenny Kohler |
First Address | Stillwater, MN 55082-5707 |
Second Address | Stillwater, MN 55082-5707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 20/11/2008 |