Healthcare Provider Details

I. General information

NPI: 1669750030
Provider Name (Legal Business Name): KALLEN S. KORIN R.N.,I.B.C.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 PARK TER
EUGENE OR
97404-3081
US

IV. Provider business mailing address

815 PARK TER
EUGENE OR
97404-3081
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-4263
  • Fax:
Mailing address:
  • Phone: 541-357-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number201140669RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number11037082
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: