Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H4784 | OR |
NPI | 1073810016 |
---|---|
Provider Name | Rachel Gerlach |
First Address | Portland, OR 97232-1127 |
Second Address | Portland, OR 97232-1127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2011 |
Last Update Date | 04/10/2012 |