Provider Demographics
NPI:1174789952
Name:CORKERY, VANCE MICHAEL (RN)
Entity type:Individual
Prefix:MR
First Name:VANCE
Middle Name:MICHAEL
Last Name:CORKERY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-3603
Mailing Address - Country:US
Mailing Address - Phone:518-312-3336
Mailing Address - Fax:518-275-0725
Practice Address - Street 1:29 CLINTON ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-3603
Practice Address - Country:US
Practice Address - Phone:518-312-3336
Practice Address - Fax:518-275-0725
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY565285-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse