Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6223 | WI |
NPI | 1003572744 |
---|---|
Provider Name | Tami Marie Christensen |
First Address | Racine, WI 53405-2242 |
Second Address | Mount Pleasant, WI 53406-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2021 |
Last Update Date | 16/11/2021 |