Provider Demographics
NPI:1023553468
Name:DESEVO, CORINNE (APN)
Entity Type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:
Last Name:DESEVO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 SHREWSBURY AVE
Mailing Address - Street 2:#300
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4964
Mailing Address - Country:US
Mailing Address - Phone:732-531-5200
Mailing Address - Fax:732-531-5836
Practice Address - Street 1:656 SHREWSBURY AVE
Practice Address - Street 2:#300
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4964
Practice Address - Country:US
Practice Address - Phone:732-531-5200
Practice Address - Fax:732-531-5836
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00674500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health