Provider Demographics
NPI:1477185163
Name:KOREIS, ERIC (MS, EMT-P)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KOREIS
Suffix:
Gender:M
Credentials:MS, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ALAMO RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-9599
Mailing Address - Country:US
Mailing Address - Phone:360-562-1618
Mailing Address - Fax:
Practice Address - Street 1:740 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2416
Practice Address - Country:US
Practice Address - Phone:360-442-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAES00115784146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic