Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 113515 | OR |
NPI | 1235672049 |
---|---|
Provider Name | Nicole Lyemone Yeats |
First Address | Portland, OR 97202-4445 |
Second Address | Portland, OR 97202-4445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2016 |
Last Update Date | 28/11/2016 |