Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 10165 | WI |
NPI | 1063950566 |
---|---|
Provider Name | Ms. Lorena Yanez-Cloud |
First Address | Hartford, WI 53027-1915 |
Second Address | Hartford, WI 53027-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2017 |
Last Update Date | 03/02/2017 |