Provider Demographics
NPI:1386686285
Name:KORT, JOANNE E (CNM, MPH)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:E
Last Name:KORT
Suffix:
Gender:F
Credentials:CNM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:NEOTSU
Mailing Address - State:OR
Mailing Address - Zip Code:97364-0827
Mailing Address - Country:US
Mailing Address - Phone:541-614-0314
Mailing Address - Fax:
Practice Address - Street 1:2937 NW HIGHWAY 101
Practice Address - Street 2:UNITE A
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4442
Practice Address - Country:US
Practice Address - Phone:541-614-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR093006718RN/N5367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP18696Medicare UPIN