Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H9107 | MN |
NPI | 1013681279 |
---|---|
Provider Name | Jill Marie Koehler |
First Address | Zimmerman, MN 55398-8931 |
Second Address | Zimmerman, MN 55398-8931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2021 |
Last Update Date | 02/08/2021 |