1841529310 NPI number — MS. CAROLYN CORBETT N.P.

Table of content: MS. CAROLYN CORBETT N.P. (NPI 1841529310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841529310 NPI number — MS. CAROLYN CORBETT N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORBETT
Provider First Name:
CAROLYN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841529310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45669
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83711-5669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-376-1737
Provider Business Mailing Address Fax Number:
208-361-2504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7280 W USTICK RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-5014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-376-1737
Provider Business Practice Location Address Fax Number:
208-361-2504
Provider Enumeration Date:
12/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  NP-949A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)