Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3232-16 | WI |
NPI | 1003320466 |
---|---|
Provider Name | Lori Sherman |
First Address | Wautoma, WI 54982-1440 |
Second Address | Mauston, WI 53948-2031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2017 |
Last Update Date | 21/11/2017 |