Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | A1627 | OR |
NPI | 1356879183 |
---|---|
Provider Name | Ms. Anneda May Ormae |
First Address | Portland, OR 97220-4456 |
Second Address | Portland, OR 97220-4456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 24/05/2017 |