Provider Demographics
NPI:1205114691
Name:WERNER, CORINNA JEAN (NP-C)
Entity type:Individual
Prefix:
First Name:CORINNA
Middle Name:JEAN
Last Name:WERNER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CORINNA
Other - Middle Name:JEAN
Other - Last Name:ORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:G5
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-2704
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:G5
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 1536586363LF0000X
MNCNP 1839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily