Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H3094 | OR |
NPI | 1053600148 |
---|---|
Provider Name | Karlene A Martin |
First Address | Corvallis, OR 97330-1759 |
Second Address | Corvallis, OR 97330-1759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 29/03/2011 |