Individual
JOSALYN MARIE MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1511 JOHNSON AVE, STE 104, BRIDGEPORT, WV 26330-1016
(304) 848-0702
(304) 848-0705
Mailing address
686 SOUTH PIKE ST, STE A, SHINNSTON, WV 26431-1043
(304) 624-4655
(304) 624-3918
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2239
WV
207Q00000X
Family Medicine Physician
58.001640
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009403
—
WV
Enumeration date
05/08/2007
Last updated
04/05/2022
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