Healthcare Provider Details

I. General information

NPI: 1073584264
Provider Name (Legal Business Name): PATRICIA LYNN MCCORKLE RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY RD BASSETT ARMY COMMUNITY HOSPITAL
FT WAINWRIGHT AK
99703-5001
US

IV. Provider business mailing address

1609 SOUTHERN AVE A
FAIRBANKS AK
99709-4230
US

V. Phone/Fax

Practice location:
  • Phone: 907-353-5158
  • Fax:
Mailing address:
  • Phone: 907-479-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number1059920
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: