Provider Demographics
NPI:1861663296
Name:KORRELL, TANYA LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:LYNNE
Last Name:KORRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 E 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4108
Mailing Address - Country:US
Mailing Address - Phone:541-682-3938
Mailing Address - Fax:480-776-0444
Practice Address - Street 1:299 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4108
Practice Address - Country:US
Practice Address - Phone:541-682-3938
Practice Address - Fax:541-682-8743
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38128208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500812142Medicaid