Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6277-16 | WI |
NPI | 1073922803 |
---|---|
Provider Name | Mary Whitney-Hartje |
First Address | Beloit, WI 53511-3550 |
Second Address | Beloit, WI 53511-3550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2014 |
Last Update Date | 06/08/2014 |