Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 5953-16 | WI |
NPI | 1033870373 |
---|---|
Provider Name | Mrs. Cara Sue Hall |
First Address | Cameron, WI 54822-9687 |
Second Address | St Francis, WI 53235-5256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2022 |
Last Update Date | 09/01/2022 |