Provider Demographics
NPI:1912142498
Name:COREY, NANCY KAY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KAY
Last Name:COREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40849 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4306
Mailing Address - Country:US
Mailing Address - Phone:510-657-7409
Mailing Address - Fax:510-657-7293
Practice Address - Street 1:40849 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4306
Practice Address - Country:US
Practice Address - Phone:510-657-7409
Practice Address - Fax:510-657-7293
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist