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General NPI Number Information
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NPI Number | 1932446390
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Entity Type | Individual
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Provider Name | PATRICIA HOOPER RDH
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Gender | Female
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Dates
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Enumeration Date | 01/04/2013
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 261 N MAIN ST
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City | DOUSMAN
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State | WI
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Zip | 53118-9305
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Country | US
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Telephone | 262-965-3662
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Fax |
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Provider Business Mailing Address
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Address Line | 420 N PRAIRIE DR
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City | OCONOMOWOC
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State | WI
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Zip | 53066-8629
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Country | US
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Telephone | 262-443-0309
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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 | 4667-016
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License Number State | WI
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