Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6789-16 | WI |
NPI | 1033360763 |
---|---|
Provider Name | Mrs. Kory Pilkington |
First Address | Franklin, WI 53132-9206 |
Second Address | Milwaukee, WI 53204-0408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 30/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33829400 | (05) | WI |