Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | MI |
NPI | 1073063236 |
---|---|
Provider Name | Krista Lynn Pietila |
First Address | Hancock, MI 49930-1644 |
Second Address | Calumet, MI 49913-2946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2016 |
Last Update Date | 11/10/2016 |