Provider Demographics
NPI:1093380552
Name:NOWOBIELSKI, KAYE LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:LYNN
Last Name:NOWOBIELSKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W9742 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:THORP
Mailing Address - State:WI
Mailing Address - Zip Code:54771-7614
Mailing Address - Country:US
Mailing Address - Phone:715-829-6731
Mailing Address - Fax:
Practice Address - Street 1:517 COURT ST RM 105
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1982
Practice Address - Country:US
Practice Address - Phone:715-743-6985
Practice Address - Fax:715-743-5115
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10289-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist