Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1002933-16 | WI |
NPI | 1053075481 |
---|---|
Provider Name | Karen Rodman |
First Address | Appleton, WI 54913-9112 |
Second Address | Appleton, WI 54913-8442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2021 |
Last Update Date | 22/10/2021 |