Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 93-0798039 | OR |
NPI | 1174096473 |
---|---|
Provider Name | Ms. Victoria Kaye Worthington |
First Address | Happy Valley, OR 97086-3762 |
Second Address | Happy Valley, OR 97086-3762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2019 |
Last Update Date | 09/01/2019 |