Provider Demographics
NPI:1205070877
Name:DE CORTE, LORRETTA DENISE (IDMT)
Entity type:Individual
Prefix:
First Name:LORRETTA
Middle Name:DENISE
Last Name:DE CORTE
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 2 BOX 11719
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0067
Mailing Address - Country:US
Mailing Address - Phone:490367-197-9621
Mailing Address - Fax:
Practice Address - Street 1:PSC 2 BOX 11719
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09012-0067
Practice Address - Country:US
Practice Address - Phone:490367-197-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians