Individual
ANTOINETTE CORSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1620 E 12TH ST, THE DALLES, OR 97058-3213
(541) 296-9151
Mailing address
1620 E 12TH ST, THE DALLES, OR 97058-3213
(541) 296-9151
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202213867NP-PP
OR
Other
Enumeration date
07/14/2020
Last updated
09/09/2022
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