Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H3834 | OR |
NPI | 1013062595 |
---|---|
Provider Name | Mrs. Cindy Lou Nonamaker |
First Address | Gresham, OR 97080-1858 |
Second Address | Clackamas, OR 97015-9782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |