Healthcare Provider Details

I. General information

NPI: 1417524067
Provider Name (Legal Business Name): TUNJIA CORBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 HIGHWAY 2
STERLINGTON LA
71280-3004
US

IV. Provider business mailing address

1607 OAK ST
WINNSBORO LA
71295-3532
US

V. Phone/Fax

Practice location:
  • Phone: 318-598-5040
  • Fax:
Mailing address:
  • Phone: 318-801-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: