Provider Demographics
NPI:1114498235
Name:KLEIN, CORINNA JO (RN)
Entity Type:Individual
Prefix:
First Name:CORINNA
Middle Name:JO
Last Name:KLEIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42470 JERRY CIR
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-9081
Mailing Address - Country:US
Mailing Address - Phone:907-953-2251
Mailing Address - Fax:
Practice Address - Street 1:42470 JERRY CIR
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-9081
Practice Address - Country:US
Practice Address - Phone:907-953-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKR20545163WI0500X, 163WN0800X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscienceGroup - Multi-Specialty