Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4524-16 | WI |
NPI | 1023666161 |
---|---|
Provider Name | Ms. Susan Marie Skrzypczak |
First Address | Menasha, WI 54952-3420 |
Second Address | Waukesha, WI 53188-2483 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2019 |
Last Update Date | 02/09/2019 |