Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1933 | TN |
NPI | 1053950436 |
---|---|
Provider Name | Kathy Landers Schaal |
First Address | Paris, TN 38242-6672 |
Second Address | Paris, TN 38242-4296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2020 |
Last Update Date | 02/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1933 | DENTAL HYGIENE (01) | TN |