Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 63781 | CA |
NPI | 1740629864 |
---|---|
Provider Name | Dr. Nichole Mckenna |
First Address | Auburn, CA 95603-9522 |
Second Address | Oakland, CA 94601-2228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 19/11/2014 |