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General NPI Number Information
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NPI Number | 1720573082
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Entity Type | Individual
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Provider Name | SUSAN EVELYN MERCHANT
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Gender | Female
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 4404 STATE ROAD 70
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City | WEBSTER
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State | WI
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Zip | 54893-9251
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Country | US
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Telephone | 715-349-8554
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Fax | 715-349-2504
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Provider Business Mailing Address
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Address Line | N3710 COUNTY HIGHWAY K
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City | SHELL LAKE
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State | WI
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Zip | 54871-8660
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Country | US
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Telephone | 715-416-0701
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 6329-16
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License Number State | WI
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