Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 100322216 | WI |
NPI | 1053886069 |
---|---|
Provider Name | Kathryn Kupczyk |
First Address | Stevens Point, WI 54481-0171 |
Second Address | Stevens Point, WI 54481-0171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2018 |
Last Update Date | 05/10/2018 |