Provider Demographics
NPI:1902410574
Name:KOREN, VALLIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:VALLIE
Middle Name:ANN
Last Name:KOREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:HAZLET TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-3041
Mailing Address - Country:US
Mailing Address - Phone:732-670-5855
Mailing Address - Fax:
Practice Address - Street 1:2040 6TH AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6101
Practice Address - Country:US
Practice Address - Phone:732-670-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15651100163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty