Provider Demographics
NPI:1346982170
Name:CORBITT, ALEXANDER (CRNA)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:CORBITT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 N CAMBRIDGE AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-0015
Mailing Address - Country:US
Mailing Address - Phone:678-634-9694
Mailing Address - Fax:
Practice Address - Street 1:510 STATE AVE NE UNIT 102B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1175
Practice Address - Country:US
Practice Address - Phone:678-634-9694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60768328163W00000X
GARN250862163W00000X
WAAP61317489367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse