Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2731-016 | WI |
NPI | 1053560136 |
---|---|
Provider Name | Mary Ellen Klement |
First Address | Wisconsin Rapids, WI 54494 |
Second Address | Nekoosa, WI 54457-8705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 15/09/2008 |