Provider Demographics
NPI:1821372731
Name:HOAD, CORRINA LILLIAN
Entity Type:Individual
Prefix:
First Name:CORRINA
Middle Name:LILLIAN
Last Name:HOAD
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 1:4325 HANRAHAN RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:NY
Mailing Address - Zip Code:14821-9759
Mailing Address - Country:US
Mailing Address - Phone:607-776-0071
Mailing Address - Fax:
Practice Address - Street 1:4325 HANRAHAN RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:NY
Practice Address - Zip Code:14821-9759
Practice Address - Country:US
Practice Address - Phone:607-776-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307042-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse