Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH60586834 | WA |
NPI | 1053946673 |
---|---|
Provider Name | Jessica Maree Carnes |
First Address | Vancouver, WA 98663 |
Second Address | Vancouver, WA 98663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2020 |
Last Update Date | 04/03/2020 |