Provider Demographics
NPI:1689563934
Name:CORKUM, ROSE MARIE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:CORKUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 E 3RD ST APT C
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-3475
Mailing Address - Country:US
Mailing Address - Phone:937-768-8804
Mailing Address - Fax:
Practice Address - Street 1:166 E 3RD ST APT C
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3475
Practice Address - Country:US
Practice Address - Phone:937-768-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker