Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5955 | OR |
NPI | 1033543681 |
---|---|
Provider Name | Mrs. Rachel Lynn Pena |
First Address | Portland, OR 97211-5906 |
Second Address | Clackamas, OR 97015-9782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 02/10/2015 |