Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6838 | OR |
NPI | 1043690878 |
---|---|
Provider Name | Quanita Anwar |
First Address | Newport, OR 97365-4992 |
Second Address | Newport, OR 97365-4992 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2015 |
Last Update Date | 07/06/2015 |