Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | H04419 | AZ |
Y | 124Q00000X | Dental Hygienist | H7965 | OR |
NPI | 1033889068 |
---|---|
Provider Name | Sandra Lee Adams |
First Address | La Grande, OR 97850-2244 |
Second Address | Hermiston, OR 97838-2108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |