Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H2618 | OR |
NPI | 1003142902 |
---|---|
Provider Name | Joanne T Van Buren |
First Address | Portland, OR 97230-5642 |
Second Address | Portland, OR 97230-5642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2009 |
Last Update Date | 27/10/2009 |