Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6278 | OR |
N | 126800000X | Dental Assistant |
NPI | 1285763573 |
---|---|
Provider Name | Amber Nichol |
First Address | Salem, OR 97301-1635 |
Second Address | Salem, OR 97305-1089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 15/04/2014 |