Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1376131011 |
---|---|
Provider Name | Rebecca Lee Carlson |
First Address | Milwaukie, OR 97267-2651 |
Second Address | Clackamas, OR 97015-9782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2021 |
Last Update Date | 07/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
93-0798039 | KAISER PERMANENTE (01) |