Healthcare Provider Details

I. General information

NPI: 1558670190
Provider Name (Legal Business Name): LINSEY L KORNYA CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4056 HUMPHREY ST
SAINT LOUIS MO
63116-3823
US

IV. Provider business mailing address

4056 HUMPHREY ST
SAINT LOUIS MO
63116-3823
US

V. Phone/Fax

Practice location:
  • Phone: 314-677-9998
  • Fax:
Mailing address:
  • Phone: 314-677-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: