Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H3321 | OR |
NPI | 1043369911 |
---|---|
Provider Name | Linda Sue Mann |
First Address | Salem, OR 97302-2244 |
Second Address | Salem, OR 97302-2244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274828 | (05) | OR |