Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4635-016 | WI |
NPI | 1033443338 |
---|---|
Provider Name | Jerilyn M Flipse |
First Address | Oostburg, WI 53070-1455 |
Second Address | Sheboygan, WI 53081-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2009 |
Last Update Date | 21/09/2009 |