Provider Demographics
NPI:1477036259
Name:KORMOS, KORTNI (LVN)
Entity Type:Individual
Prefix:
First Name:KORTNI
Middle Name:
Last Name:KORMOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 STATE HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:GLENN
Mailing Address - State:CA
Mailing Address - Zip Code:95943-9647
Mailing Address - Country:US
Mailing Address - Phone:530-812-4372
Mailing Address - Fax:
Practice Address - Street 1:555 FLYING V ST STE 5
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7698
Practice Address - Country:US
Practice Address - Phone:530-899-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264728164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse