Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2372 | NE |
NPI | 1063957108 |
---|---|
Provider Name | Michelle Schramm |
First Address | Norfolk, NE 68701-5248 |
Second Address | Norfolk, NE 68701-5248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2016 |
Last Update Date | 28/12/2016 |