Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H7827 | OR |
NPI | 1053964353 |
---|---|
Provider Name | Allyson Anderson |
First Address | Redmond, OR 97756-6959 |
Second Address | Salem, OR 97301-1803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2019 |
Last Update Date | 17/07/2019 |