Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5792015 | WI |
NPI | 1003842204 |
---|---|
Provider Name | Mrs. Betsy A Newhouse Hanna |
First Address | Prairie Du Sac, WI 53578-2041 |
Second Address | Prairie Du Sac, WI 53578-2041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 08/07/2007 |