Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 5674-016 | WI |
NPI | 1033313960 |
---|---|
Provider Name | Ms. Geralyn Travia |
First Address | Milwaukee, WI 53226-1800 |
Second Address | Milwaukee, WI 53226-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5674-016 | DENTAL HYGIENIST (01) | WI |