Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H4365 | OR |
NPI | 1003854506 |
---|---|
Provider Name | Mrs. Laine Corinne Ewry |
First Address | Portland, OR 97266-4966 |
Second Address | Portland, OR 97216-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 08/07/2007 |