Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6159 | OR |
NPI | 1073899894 |
---|---|
Provider Name | Julia Duffy |
First Address | Portland, OR 97217-3509 |
Second Address | Portland, OR 97217-3509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2011 |
Last Update Date | 25/10/2011 |