Provider Demographics
NPI:1740269919
Name:KORMAN, RITA CAROLYN (CPNP, IBCLC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:CAROLYN
Last Name:KORMAN
Suffix:
Gender:F
Credentials:CPNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17553 640TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:MN
Mailing Address - Zip Code:56009-5409
Mailing Address - Country:US
Mailing Address - Phone:507-874-3180
Mailing Address - Fax:
Practice Address - Street 1:404 W FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2437
Practice Address - Country:US
Practice Address - Phone:507-373-2384
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 057423-5363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
S90761Medicare UPIN