Provider Demographics
NPI:1851563092
Name:MCKINNEY, CORETTA T (LVN)
Entity Type:Individual
Prefix:
First Name:CORETTA
Middle Name:T
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CORETTA
Other - Middle Name:T
Other - Last Name:LEDUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2943
Mailing Address - Country:US
Mailing Address - Phone:562-591-8701
Mailing Address - Fax:562-591-6841
Practice Address - Street 1:490 W 14TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2943
Practice Address - Country:US
Practice Address - Phone:562-591-8701
Practice Address - Fax:562-591-6841
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 158852164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse