Provider Demographics
NPI:1407894363
Name:LAMM, CORRINE LORRAINE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:LORRAINE
Last Name:LAMM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:CORRINE
Other - Middle Name:
Other - Last Name:KIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 NATIONAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-729-0050
Mailing Address - Fax:301-729-6897
Practice Address - Street 1:920 NATIONAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-759-4544
Practice Address - Fax:301-723-4446
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR081551163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522159044Medicaid
MD522159044Medicaid
MDP84092Medicare UPIN
754LJ905Medicare PIN