Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5361 | OR |
NPI | 1083053268 |
---|---|
Provider Name | Erika Nicole Evans |
First Address | Klamath Falls, OR 97601-4356 |
Second Address | Klamath Falls, OR 97601-4356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 20/06/2013 |