Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 112057 | OR |
NPI | 1285724021 |
---|---|
Provider Name | Rachael Annette Chambers |
First Address | Portland, OR 97233 |
Second Address | Portland, OR 97217-5523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |