Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6113 | OR |
NPI | 1033563788 |
---|---|
Provider Name | Risa Frank |
First Address | Joseph, OR 97846-5001 |
Second Address | Joseph, OR 97846-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 19/04/2016 |