Provider Demographics
NPI:1124465372
Name:NORTHWEST MOBILE HYGIENE, LLC
Entity type:Organization
Organization Name:NORTHWEST MOBILE HYGIENE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:WENDY
Authorized Official - Last Name:FATAFEHI
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, BS, EPDH
Authorized Official - Phone:503-440-2313
Mailing Address - Street 1:PO BOX 7014
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-7014
Mailing Address - Country:US
Mailing Address - Phone:503-440-2313
Mailing Address - Fax:
Practice Address - Street 1:20392 SW BLAINE CT
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-2115
Practice Address - Country:US
Practice Address - Phone:503-440-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6359124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty