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Individual

MRS. JENIFER LYNN FOLAU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
63897 WALLACE RD, COOS BAY, OR 97420-8779
(541) 982-9793
Mailing address
63897 WALLACE RD, COOS BAY, OR 97420-8779
(541) 982-9793

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
74641487
OR

Other

Enumeration date
05/01/2018
Last updated
05/01/2018
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