Healthcare Provider Details

I. General information

NPI: 1114498235
Provider Name (Legal Business Name): CORINNA JO KLEIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42470 JERRY CIR
SOLDOTNA AK
99669-9081
US

IV. Provider business mailing address

42470 JERRY CIR
SOLDOTNA AK
99669-9081
US

V. Phone/Fax

Practice location:
  • Phone: 907-953-2251
  • Fax:
Mailing address:
  • Phone: 907-953-2251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberR20545
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberR20545
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR20545
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: