Provider Demographics
NPI:1841529310
Name:CORBETT, CAROLYN (NP)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:NP
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 45669
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-5669
Mailing Address - Country:US
Mailing Address - Phone:208-376-1737
Mailing Address - Fax:208-361-2504
Practice Address - Street 1:7280 W USTICK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5014
Practice Address - Country:US
Practice Address - Phone:208-376-1737
Practice Address - Fax:208-361-2504
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-949A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health