Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3507-16 | WI |
NPI | 1073940136 |
---|---|
Provider Name | Sarah Jean Galloy |
First Address | Lac Du Flambeau, WI 54538-0128 |
Second Address | Lac Du Flambeau, WI 54538-0128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2013 |
Last Update Date | 03/10/2013 |