Individual
SANDRA SUE LISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
980 SW 6TH ST, SUITE 25, GRANTS PASS, OR 97526-2910
(541) 471-6299
Mailing address
924 NE 11TH ST, GRANTS PASS, OR 97526-1658
(541) 471-6299
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4339
OR
Other
Enumeration date
05/25/2007
Last updated
07/08/2007
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