Provider Demographics
NPI:1639159726
Name:KOROL, THERESA L (NP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:L
Last Name:KOROL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-1920
Mailing Address - Country:US
Mailing Address - Phone:315-894-5643
Mailing Address - Fax:
Practice Address - Street 1:1904 GENESEE ST
Practice Address - Street 2:INDEPENDENT PHYSICIANS URGENT CARE
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5662
Practice Address - Country:US
Practice Address - Phone:315-793-8856
Practice Address - Fax:315-793-8307
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily