Healthcare Provider Details

I. General information

NPI: 1457281529
Provider Name (Legal Business Name): KORRIN GHOLSTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

6115 HIL MAR DR
DISTRICT HEIGHTS MD
20747-2978
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7000
  • Fax:
Mailing address:
  • Phone: 630-808-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN1047161
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: