Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6234 | OR |
NPI | 1023479201 |
---|---|
Provider Name | Kourtni Faber |
First Address | Medford, OR 97504-6139 |
Second Address | White City, OR 97503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2016 |
Last Update Date | 16/08/2018 |