Individual
JUSTIN MANDEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9391 PRARRIE WIND ST, YELM, WA 98597
(517) 667-8729
Mailing address
BLDG 11582 C STREET, OKUBO CLINIC, JBLM, WA 98433
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/03/2018
Last updated
07/25/2023
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