Individual
JARED B CORNELISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3901 CAPITAL MALL DR SW, STE A, OLYMPIA, WA 98502-1178
(360) 786-8990
(360) 786-9010
Mailing address
431 N 15TH AVE, POCATELLO, ID 83201-4058
(208) 339-5726
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60360929
WA
Other
Enumeration date
10/22/2012
Last updated
05/28/2013
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