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NPI Code Detail

MEDICARE: JEANETTE PAHL

MEDICARE: JEANETTE PAHL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist11605-16WI

General Provider Information

NPI Number : 1417764986
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANETTE PAHL
Provider Business Mailing Address
First Line : 5616 W CARLSVILLE RD
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-9741
Country : US
Telephone Number : 920-419-1924
Fax Number :
Provider Business Practice Location Address
First Line : 228 S 18TH AVE
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1000
Country : US
Telephone Number : 920-746-3788
Fax Number : 920-743-3340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2024
Last Update Date : 12/17/2024

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Directions to “ JEANETTE PAHL ” Practice Location

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