Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | ||
Y | 126800000X | Dental Assistant |
NPI | 1346690047 |
---|---|
Provider Name | Vickie Bjorson |
First Address | Fort Lee, VA 23801-1526 |
Second Address | Fort Lee, VA 23801-1526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2016 |
Last Update Date | 14/06/2016 |