Healthcare Provider Details

I. General information

NPI: 1912217944
Provider Name (Legal Business Name): KACIE MARIE MECHELS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 E WASHINGTON AVE
MADISON WI
53704-4155
US

IV. Provider business mailing address

2901 W BELTLINE HWY BOX A
MADISON WI
53713-4226
US

V. Phone/Fax

Practice location:
  • Phone: 608-443-5482
  • Fax: 608-443-5570
Mailing address:
  • Phone: 608-443-5480
  • Fax: 608-441-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10283-16
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: