MEDICARE: KORINA L FORTNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1063232916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORINA L FORTNER

Provider Business Mailing Address
First Line	:	420 WATSON PL SE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44707-3857
Country	:	US
Telephone Number	:	330-607-5681
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 WATSON PL SE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44707-3857
Country	:	US
Telephone Number	:	330-607-5681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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Directions to “ KORINA L FORTNER ” Practice Location

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