Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6848 | OR |
NPI | 1003296344 |
---|---|
Provider Name | Ms. Erika Grandjean |
First Address | Portland, OR 97204-2416 |
Second Address | Portland, OR 97204-2416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2015 |
Last Update Date | 02/06/2015 |