Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 5072-16 | WI |
NPI | 1023388188 |
---|---|
Provider Name | Susanne Rose Knight |
First Address | Turtle Lake, WI 54889-0000 |
Second Address | Turtle Lake, WI 54889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2012 |
Last Update Date | 06/01/2012 |