Provider Demographics
NPI:1982614764
Name:CORBETT, RENE ROYAL (RN, MSN, APRN-BC, NP)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:ROYAL
Last Name:CORBETT
Suffix:
Gender:F
Credentials:RN, MSN, APRN-BC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 PHYSICIANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7335
Mailing Address - Country:US
Mailing Address - Phone:910-796-7900
Mailing Address - Fax:910-796-7901
Practice Address - Street 1:1414 PHYSICIANS DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7335
Practice Address - Country:US
Practice Address - Phone:910-796-7900
Practice Address - Fax:910-796-7901
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600137363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003711Medicaid
NCQ28271Medicare UPIN
NC7003711Medicaid