Individual
KALLIE M BASHOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
830 OSTRUM ST, FOUNTAIN HILL, PA 18015-1013
(908) 859-6722
Mailing address
2033 W HIGHLAND ST, ALLENTOWN, PA 18104-3741
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3351-23
WI
363AM0700X
Medical Physician Assistant
Primary
MA057499
PA
Other
Enumeration date
07/09/2014
Last updated
10/09/2015
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