Provider Demographics
NPI:1942542790
Name:CORR, LINDA DENISE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DENISE
Last Name:CORR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9623 YELLOW PINE ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505
Mailing Address - Country:US
Mailing Address - Phone:402-560-9736
Mailing Address - Fax:
Practice Address - Street 1:4451 N 26TH ST STE 1000
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4144
Practice Address - Country:US
Practice Address - Phone:402-476-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant