Provider Demographics
NPI:1457766107
Name:ABBOTT, COREY MARIE (NP)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MARIE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:MARIE
Other - Last Name:FERRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:431 CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2754
Mailing Address - Country:US
Mailing Address - Phone:909-305-3113
Mailing Address - Fax:
Practice Address - Street 1:431 CHAMPLAIN DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2754
Practice Address - Country:US
Practice Address - Phone:909-305-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000596363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health