Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5797 | OR |
NPI | 1023408481 |
---|---|
Provider Name | Shaunna Jennings |
First Address | Eugene, OR 97404-2036 |
Second Address | Cottage Grove, OR 97424-2245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2015 |
Last Update Date | 23/01/2015 |