Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902011838 | MI |
NPI | 1063721207 |
---|---|
Provider Name | Mrs. Jennifer Ann Van Wingen |
First Address | Traverse City, MI 49684-7173 |
Second Address | Traverse City, MI 49684-7173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2010 |
Last Update Date | 06/10/2010 |