Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 10674016 | WI |
NPI | 1063751022 |
---|---|
Provider Name | Sheri R Brunette |
First Address | Turtle Lake, WI 54889-9191 |
Second Address | Turtle Lake, WI 54889-9191 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2013 |
Last Update Date | 11/02/2013 |