Provider Demographics
NPI:1548432479
Name:GUINN, CORINNE DIANE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:DIANE
Last Name:GUINN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5297 MILL RD
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:WI
Mailing Address - Zip Code:54921-9526
Mailing Address - Country:US
Mailing Address - Phone:715-335-6086
Mailing Address - Fax:715-335-6086
Practice Address - Street 1:5297 MILL RD
Practice Address - Street 2:
Practice Address - City:BANCROFT
Practice Address - State:WI
Practice Address - Zip Code:54921-9526
Practice Address - Country:US
Practice Address - Phone:715-335-6086
Practice Address - Fax:715-335-6086
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29766164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35054700Medicaid