Provider Demographics
NPI:1407406739
Name:CORBETT, URSULA D (PA-C)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:D
Last Name:CORBETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CRMC FAMILY PHYSICIAN ARROWHEAD CLINIC
Mailing Address - Street 2:6307 E STATE RD
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-9063
Mailing Address - Country:US
Mailing Address - Phone:740-498-5515
Mailing Address - Fax:
Practice Address - Street 1:6307 E STATE RD
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-9063
Practice Address - Country:US
Practice Address - Phone:740-498-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006124RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant