Individual
KORI MADISON PLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 MEDICAL CENTER DR, LEBANON, NH 03756-0001
(603) 650-5000
Mailing address
PO BOX 810, HANOVER, NH 03755-0810
(603) 308-1472
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2121
NH
363A00000X
Physician Assistant
—
—
Other
Enumeration date
09/05/2023
Last updated
02/12/2024
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