Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1043652084 |
---|---|
Provider Name | Jennifer Osborn |
First Address | Spokane, WA 99201-0254 |
Second Address | Spokane, WA 99205-1349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2013 |
Last Update Date | 25/07/2013 |