Provider Demographics
NPI:1669750030
Name:KORIN, KALLEN S (RN,IBCLC)
Entity type:Individual
Prefix:
First Name:KALLEN
Middle Name:S
Last Name:KORIN
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 PARK TER
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3081
Mailing Address - Country:US
Mailing Address - Phone:541-357-4263
Mailing Address - Fax:
Practice Address - Street 1:815 PARK TER
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3081
Practice Address - Country:US
Practice Address - Phone:541-357-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201140669RN163WL0100X
NC11037082163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant