Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6031 | OR |
NPI | 1053854125 |
---|---|
Provider Name | Rachel Murdock |
First Address | Medford, OR 97501-8957 |
Second Address | Medford, OR 97504-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2016 |
Last Update Date | 22/11/2016 |