Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6511 | OR |
NPI | 1043644685 |
---|---|
Provider Name | Mrs. Kathina Justice |
First Address | Mcminnville, OR 97128-9259 |
Second Address | Mcminnville, OR 97128-9259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2013 |
Last Update Date | 31/08/2013 |