Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 0517999190 | OR |
NPI | 1467667139 |
---|---|
Provider Name | Mrs. Diana K Helvey |
First Address | Medford, OR 97501 |
Second Address | Jacksonville, OR 97530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |