Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1346705647 |
---|---|
Provider Name | Alina Ferguson |
First Address | Salem, OR 97306-9427 |
Second Address | Salem, OR 97306-9427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2019 |
Last Update Date | 31/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
93-0798039 | KAISER PERMANENTE (01) | OR |