Provider Demographics
NPI:1922345222
Name:PONTE, CORRIN M (RN, BSN)
Entity Type:Individual
Prefix:
First Name:CORRIN
Middle Name:M
Last Name:PONTE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 128TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4062
Mailing Address - Country:US
Mailing Address - Phone:425-746-2783
Mailing Address - Fax:
Practice Address - Street 1:14310 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5520
Practice Address - Country:US
Practice Address - Phone:425-456-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00123359163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse