Provider Demographics
NPI:1952054744
Name:CRESS, KOREY
Entity Type:Individual
Prefix:
First Name:KOREY
Middle Name:
Last Name:CRESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2274
Mailing Address - Country:US
Mailing Address - Phone:419-910-1103
Mailing Address - Fax:
Practice Address - Street 1:1604 W WAYNE ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2274
Practice Address - Country:US
Practice Address - Phone:419-910-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver