Individual
MS. SANDRA LEIGH KOSIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
200 S HAZEL DELL WAY, CANBY, OR 97013-7829
(503) 263-9500
(503) 263-1383
Mailing address
18465 S WINNIFRED AVE, MOLALLA, OR 97038-8847
(503) 319-5810
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00850
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136296
—
OR
Enumeration date
03/06/2006
Last updated
12/26/2012
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