Provider Demographics
NPI:1801077870
Name:WERNER, CORRENE (RN, BSN, IBCLC, RLC)
Entity type:Individual
Prefix:MRS
First Name:CORRENE
Middle Name:
Last Name:WERNER
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 720831
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4521
Mailing Address - Country:US
Mailing Address - Phone:347-287-5278
Mailing Address - Fax:
Practice Address - Street 1:35-36 76TH STREET
Practice Address - Street 2:APARTMENT 509
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4521
Practice Address - Country:US
Practice Address - Phone:347-287-5278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599780-1163W00000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse