Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D6433 | OR |
NPI | 1700983871 |
---|---|
Provider Name | Dr. Laura Thompson Nelson |
First Address | Tigard, OR 97223-4290 |
Second Address | Gresham, OR 97030-7317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |