Provider Demographics
NPI:1285186163
Name:CORWIN, NICOLE CASSIE (NP, RN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CASSIE
Last Name:CORWIN
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:FIVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:301 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2603
Mailing Address - Country:US
Mailing Address - Phone:650-632-0817
Mailing Address - Fax:
Practice Address - Street 1:77 N SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2889
Practice Address - Country:US
Practice Address - Phone:650-342-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004876363LP0222X, 363L00000X
CA834973163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency