Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1002889 | WI |
NPI | 1023563681 |
---|---|
Provider Name | Tashina Kroll |
First Address | Mount Horeb, WI 53572-2379 |
Second Address | Marshall, WI 53559-9735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2016 |
Last Update Date | 23/08/2016 |