=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649925942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET ALICE STOLLEY RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2022
-----------------------------------------------------
Last Update Date | 02/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 345 E PATTISON ST
-----------------------------------------------------
City | ELY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55731-1537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-502-2268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 345 E PATTISON ST
-----------------------------------------------------
City | ELY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55731-1537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 160-350-2226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | H3222
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------