Provider Demographics
NPI:1568237303
Name:AGUON, CORINA ROSE MESA (CNA)
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:ROSE MESA
Last Name:AGUON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:CORINA
Other - Middle Name:ROSE
Other - Last Name:MESA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:PO BOX 3567
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-3567
Mailing Address - Country:US
Mailing Address - Phone:360-473-7037
Mailing Address - Fax:
Practice Address - Street 1:9220 WHITE TOP AVE NE UNIT B
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-3117
Practice Address - Country:US
Practice Address - Phone:360-473-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC61118872202K00000X
WANC60994786376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology