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Individual

JONNIE WHITCOMB

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
1843 NE 3RD ST STE 2, BEND, OR 97701-3816
(541) 350-5431
Mailing address
20474 JACKLIGHT LN, BEND, OR 97702-3074
(541) 350-5431

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
15718
OR

Other

Enumeration date
04/27/2016
Last updated
04/27/2016
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