Provider Demographics
NPI:1609323146
Name:NORDYKE, CORY LYNN (LMT, MMP)
Entity Type:Individual
Prefix:MRS
First Name:CORY
Middle Name:LYNN
Last Name:NORDYKE
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CARROCK WAY
Mailing Address - Street 2:
Mailing Address - City:TAMIMENT
Mailing Address - State:PA
Mailing Address - Zip Code:18371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 CARROCK WAY
Practice Address - Street 2:
Practice Address - City:TAMIMENT
Practice Address - State:PA
Practice Address - Zip Code:18371
Practice Address - Country:US
Practice Address - Phone:570-431-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG010794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist