Provider Demographics
NPI:1356420475
Name:CORBETT, NANCY (PA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8592
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-0592
Mailing Address - Country:US
Mailing Address - Phone:425-899-5510
Mailing Address - Fax:425-899-5524
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE 520
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-899-5510
Practice Address - Fax:425-899-5524
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003334363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6622COOtherREGENCE
WA0172759OtherLABOR AND INDUSTRIES
WAP00186955OtherRAILROAD MEDICARE
WA0172759OtherLABOR AND INDUSTRIES
WA6622COOtherREGENCE