Individual
JAN L MANTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
16244 13TH AVE SW, BURIEN, WA 98166-2814
(206) 241-4625
Mailing address
16244 13TH AVE SW, BURIEN, WA 98166-2814
(206) 241-4625
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00009697
WA
Other
Enumeration date
03/14/2008
Last updated
03/14/2008
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