Provider Demographics
NPI:1114013844
Name:CORZINE, PAMELA L (NP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:L
Last Name:CORZINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:250 FISCHER DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3467
Mailing Address - Country:US
Mailing Address - Phone:734-326-6045
Mailing Address - Fax:
Practice Address - Street 1:20317 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1411
Practice Address - Country:US
Practice Address - Phone:248-615-0777
Practice Address - Fax:248-615-0779
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704135735363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS91895Medicare UPIN