Healthcare Provider Details

I. General information

NPI: 1518977305
Provider Name (Legal Business Name): CHRISTINE M CORBY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1007 MILITARY ST
PORT HURON MI
48060-5416
US

IV. Provider business mailing address

3202 RABIDUE RD
CLYDE MI
48049-4106
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-7050
  • Fax: 810-987-2336
Mailing address:
  • Phone: 810-985-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704172552
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: