Organization
KORY MARSLAND CORPORATION
Active
Other names
Leading Edge Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TISHA PALMER RN (PRACTICE MANAGER)
(608) 400-0141
Entity
Organization
Contact information
Practice address
213 TIOGA ST UNIT 6834, ITHACA, NY 14851-8068
(608) 400-0141
(608) 561-8745
Mailing address
1115 1ST ST N, STILLWATER, MN 55082-4037
(608) 400-0141
(608) 561-8745
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
364S00000X
Clinical Nurse Specialist
—
—
Other
Enumeration date
05/22/2024
Last updated
05/22/2024
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