Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4561 | WI |
NPI | 1013188481 |
---|---|
Provider Name | Mrs. Jodi Jean Carr |
First Address | Onalaska, WI 54650-8646 |
Second Address | Onalaska, WI 54650-8646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2008 |
Last Update Date | 13/03/2008 |