Provider Demographics
NPI:1508610445
Name:AUSTIN, CORINNE ALYSSA (FNP)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:ALYSSA
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:ALYSSA
Other - Last Name:BARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3396 W THORNDALE LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9736
Mailing Address - Country:US
Mailing Address - Phone:434-282-4105
Mailing Address - Fax:
Practice Address - Street 1:1431 N LIBERTY LAKE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8522
Practice Address - Country:US
Practice Address - Phone:509-928-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61537381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily