Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 113960 | OR |
NPI | 1356472112 |
---|---|
Provider Name | Ms. Nicole Michelle Noonan-Underwood |
First Address | Camas, WA 98607-2204 |
Second Address | Vancouver, WA 98684-6053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |