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General NPI Number Information
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NPI Number | 1942699103
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Entity Type | Individual
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Provider Name | NICOLE KATHLEEN GEISSLER-BALTS RDH
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Gender | Female
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | N3104 1002ND ST
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City | ELK MOUND
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State | WI
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Zip | 54739-2011
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Country | US
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Telephone | 715-491-6056
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Fax |
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Provider Business Mailing Address
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Address Line | N3104 1002ND ST
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City | ELK MOUND
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State | WI
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Zip | 54739-2011
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Country | US
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Telephone | 715-491-6056
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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 | 9972-016
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License Number State | WI
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