Individual
KYLIE MARAN FONTENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1233 EDGEWATER ST NW, SALEM, OR 97304-4049
(503) 378-7526
(503) 585-4278
Mailing address
1233 EDGEWATER ST NW, SALEM, OR 97304-4049
(503) 378-7526
(503) 585-4278
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA130055
OR
Other
Enumeration date
08/05/2009
Last updated
08/11/2009
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