Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4456 | WI |
NPI | 1013558642 |
---|---|
Provider Name | Judith L Bellamy |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53216-1382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2019 |
Last Update Date | 04/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4456-26 | WISCONSIN LICENSE (01) | WI |