Individual
KORI MANSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
307 FERN AVE, BROOKINGS, OR 97415-2533
(541) 412-3810
Mailing address
612 WINCHUCK RIVER RD, BROOKINGS, OR 97415-8313
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
06/30/2017
Last updated
06/30/2017
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