Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H7847 | OR |
NPI | 1053956573 |
---|---|
Provider Name | Frosina Chernishov |
First Address | Woodburn, OR 97071-5585 |
Second Address | Woodburn, OR 97071-5585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2019 |
Last Update Date | 23/12/2021 |