Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H1075 | OR |
NPI | 1073527396 |
---|---|
Provider Name | Carolyn Lee Hahn |
First Address | Salem, OR 97306-1159 |
Second Address | Salem, OR 97306-9427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 08/07/2007 |