Provider Demographics
NPI:1467875922
Name:KORIOUKHINA, MAIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MAIA
Middle Name:
Last Name:KORIOUKHINA
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 1:375 SE NORTON LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8484
Mailing Address - Country:US
Mailing Address - Phone:503-472-9002
Mailing Address - Fax:503-474-2649
Practice Address - Street 1:375 SE NORTON LN
Practice Address - Street 2:SUITE A
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8484
Practice Address - Country:US
Practice Address - Phone:503-472-9002
Practice Address - Fax:503-474-2649
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant