Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 020.007667 | IL |
Y | 124Q00000X | Dental Hygienist | 6706-16 | WI |
NPI | 1053690552 |
---|---|
Provider Name | Mrs. Sandra Jean Schroeder |
First Address | Sun Prairie, WI 53590-9384 |
Second Address | Sun Prairie, WI 53590-9384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2011 |
Last Update Date | 31/10/2016 |