Provider Demographics
NPI:1528534252
Name:DEMAREE, CORRINE RENEE (RN)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:RENEE
Last Name:DEMAREE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CORRINE
Other - Middle Name:RENEE
Other - Last Name:WOODS, BUIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2674 BRIANLANE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-1642
Mailing Address - Country:US
Mailing Address - Phone:614-974-8792
Mailing Address - Fax:
Practice Address - Street 1:2674 BRIANLANE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-1642
Practice Address - Country:US
Practice Address - Phone:614-974-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN402516163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS$$$$$$$$$Medicaid