Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5141 | OR |
NPI | 1063981983 |
---|---|
Provider Name | Heather Walker |
First Address | Hood River, OR 97031-9626 |
Second Address | Hood River, OR 97031-9626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2018 |
Last Update Date | 20/11/2018 |