Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D11397 | OR |
NPI | 1457429631 |
---|---|
Provider Name | Lorena Yoko Lavarne |
First Address | Corvallis, OR 97330-5298 |
Second Address | Corvallis, OR 97330-5223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/02/2022 |