Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 02679 | IA |
NPI | 1023198934 |
---|---|
Provider Name | Stephanie Miecznikowski |
First Address | Iowa City, IA 52240-6665 |
Second Address | Iowa City, IA 52240-6665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1495 | ANESTHSIA (01) | IA |