Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6304 | OR |
N | 126800000X | Dental Assistant | 113959 | OR |
NPI | 1043437148 |
---|---|
Provider Name | Michelle Ann Vaughn |
First Address | Portland, OR 97236-5013 |
Second Address | Clackamas, OR 97015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 25/09/2012 |