Provider Demographics
NPI:1922078724
Name:COREY, PATRICIA A (ANP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:COREY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7791 MCCARTHY BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SIDE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55781-8452
Mailing Address - Country:US
Mailing Address - Phone:218-254-2530
Mailing Address - Fax:
Practice Address - Street 1:505 S 12TH AVE W
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3099
Practice Address - Country:US
Practice Address - Phone:218-741-8192
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0434236363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN68G07COOtherBCBS MN
1016952OtherPREFERRED ONE
1067919OtherAMERICA'S PPO (ARAZ)
HP22429OtherHEALTH PARTNERS
111459OtherUCARE
04-10545OtherMEDICA
P32246Medicare UPIN