Provider Demographics
NPI:1679688287
Name:ANDERSON, CORRINE LYN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:LYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-3210
Mailing Address - Country:US
Mailing Address - Phone:724-658-7300
Mailing Address - Fax:724-658-8414
Practice Address - Street 1:3410 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3210
Practice Address - Country:US
Practice Address - Phone:724-658-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2365363A00000X
PAMA052090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
092265LCKMedicare ID - Type Unspecified
Q19827Medicare UPIN