Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6786 | OR |
NPI | 1043716731 |
---|---|
Provider Name | Laura Vanderwerf |
First Address | Hillsboro, OR 97124-2979 |
Second Address | Hillsboro, OR 97124-5506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2018 |
Last Update Date | 02/04/2018 |