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Individual

DR. CARISSA SARAH COUSINS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
121 SE VIEWMONT AVE, CORVALLIS, OR 97333-1968
(541) 766-3546
Mailing address
PO BOX 1188, CORVALLIS, OR 97339-1188
(541) 812-5111
(541) 812-5127

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
096165
OH
208000000X
Pediatrics Physician
156114
OR
208000000X
Pediatrics Physician
Primary
MD156114
OR
208000000X
Pediatrics Physician
ME78852
FL

Other

Enumeration date
05/03/2006
Last updated
02/17/2021
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