Provider Demographics
NPI:1689954448
Name:BARNETT, CORINNE LEIGH (LPN)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:LEIGH
Last Name:BARNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSSER LN
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3651
Mailing Address - Country:US
Mailing Address - Phone:814-596-3650
Mailing Address - Fax:
Practice Address - Street 1:30 PROSSER LN
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3651
Practice Address - Country:US
Practice Address - Phone:814-596-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298764164W00000X
NY72987641251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1689954448Medicaid