Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 10071-016 | WI |
NPI | 1053797241 |
---|---|
Provider Name | Miss Tanelle Nelson |
First Address | Janesville, WI 53546-5656 |
Second Address | Janesville, WI 53546-5656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2015 |
Last Update Date | 11/08/2015 |