Provider Demographics
NPI:1962824433
Name:CORBIN, LAURA (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CORBIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12455 E 100TH ST N
Mailing Address - Street 2:STE 350
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4674
Mailing Address - Country:US
Mailing Address - Phone:918-274-5510
Mailing Address - Fax:918-274-5519
Practice Address - Street 1:12455 E 100TH ST N
Practice Address - Street 2:STE 350
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4674
Practice Address - Country:US
Practice Address - Phone:918-274-5510
Practice Address - Fax:918-274-5519
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant