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NPI Code Detail

MEDICARE: MRS. CORRINE LYN ANDERSON PA-C

MEDICARE: MRS. CORRINE LYN ANDERSON PA-C
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
1363A00000XPhysician Assistant2365OH
2363A00000XPhysician AssistantMA052090PA

General Provider Information

NPI Number : 1679688287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CORRINE LYN ANDERSON PA-C
Provider Business Mailing Address
First Line : 3410 WILMINGTON RD
Second Line :
City : NEW CASTLE
State : PA
Zip : 16105-3210
Country : US
Telephone Number : 724-658-7300
Fax Number : 724-658-8414
Provider Business Practice Location Address
First Line : 3410 WILMINGTON RD
Second Line :
City : NEW CASTLE
State : PA
Zip : 16105-3210
Country : US
Telephone Number : 724-658-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 06/08/2021

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