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General NPI Number Information
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NPI Number | 1528373164
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Entity Type | Individual
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Provider Name | LORI KILLEN AUS RDH, MA
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Gender | Female
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 412 NE FORD ST
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City | MCMINNVILLE
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State | OR
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Zip | 97128-4608
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Country | US
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Telephone | 503-434-7477
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Fax | 503-472-9731
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Provider Business Mailing Address
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Address Line | 2574 TROY CT
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City | WEST LINN
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State | OR
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Zip | 97068-7306
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Country | US
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Telephone | 503-657-5046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 1599
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License Number State | OR
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