Provider Demographics
NPI:1003357211
Name:CORKRAN, WENDY (CRNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CORKRAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 E RANIER DR
Mailing Address - Street 2:
Mailing Address - City:PARSONSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21849-2506
Mailing Address - Country:US
Mailing Address - Phone:717-377-2837
Mailing Address - Fax:
Practice Address - Street 1:8 E GROVE ST
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:DE
Practice Address - Zip Code:19940-1115
Practice Address - Country:US
Practice Address - Phone:302-846-0618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily