Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6611 | OR |
NPI | 1023446671 |
---|---|
Provider Name | Kristin Nicole Hockema |
First Address | Salem, OR 97301 |
Second Address | Salem, OR 97301-1803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2013 |
Last Update Date | 08/09/2015 |