Basic Information
| Provider Information | |||||||||
| NPI: | 1669567251 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUCHER | ||||||||
| FirstName: | CORINNA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MORTON | ||||||||
| OtherFirstName: | CORINNA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10470 OLD PLACERVILLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958272539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004700071 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8170 LAGUNA BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957587901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164786565 | ||||||||
| FaxNumber: | 9166915916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA12384 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | PA12384 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.