Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6604 | OR |
NPI | 1043645237 |
---|---|
Provider Name | Abigail D Ellis |
First Address | Canby, OR 97013-4150 |
Second Address | Canby, OR 97013-4150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2013 |
Last Update Date | 06/09/2013 |