Provider Demographics
NPI:1548594781
Name:BASTIEN, CORINE M (APN)
Entity Type:Individual
Prefix:
First Name:CORINE
Middle Name:M
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CORINE
Other - Middle Name:M
Other - Last Name:CYRUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3522 W LISBON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1953
Mailing Address - Country:US
Mailing Address - Phone:414-935-8000
Mailing Address - Fax:414-935-8011
Practice Address - Street 1:3522 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1953
Practice Address - Country:US
Practice Address - Phone:414-935-8000
Practice Address - Fax:414-935-8011
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3844-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner