Provider Demographics
NPI:1952066763
Name:KORPA, RENEE LYNN (NP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:KORPA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3555
Mailing Address - Country:US
Mailing Address - Phone:419-340-0257
Mailing Address - Fax:
Practice Address - Street 1:1128 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3555
Practice Address - Country:US
Practice Address - Phone:419-340-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0029624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner