Provider Demographics
NPI:1033483565
Name:KINGDON, CORINA MARIE
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:MARIE
Last Name:KINGDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40903 236TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8606
Mailing Address - Country:US
Mailing Address - Phone:360-825-6525
Mailing Address - Fax:
Practice Address - Street 1:40903 236TH AVE SE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-8606
Practice Address - Country:US
Practice Address - Phone:360-825-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00167070163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse