Basic Information
Provider Information
NPI: 1710499124
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CORBIN
FirstName: NATALIY
MiddleName: V
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 WILLIAM PENN PLZ
Address2:  
City: DURHAM
State: NC
PostalCode: 277042150
CountryCode: US
TelephoneNumber: 9192205255
FaxNumber: 9193131276
Practice Location
Address1: 1111 HUFFMAN MILL RD
Address2:  
City: BURLINGTON
State: NC
PostalCode: 272158862
CountryCode: US
TelephoneNumber: 3365845544
FaxNumber: 9193131276
Other Information
ProviderEnumerationDate: 10/26/2017
LastUpdateDate: 12/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/10/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X5010025NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home