Healthcare Provider Details

I. General information

NPI: 1366014102
Provider Name (Legal Business Name): ASHLEY L KOREN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RENAISSANCE DR STE 103
BUTLER PA
16001-7612
US

IV. Provider business mailing address

200 RENAISSANCE DR STE 103
BUTLER PA
16001-7612
US

V. Phone/Fax

Practice location:
  • Phone: 724-256-9606
  • Fax: 724-256-9609
Mailing address:
  • Phone: 724-256-9606
  • Fax: 724-256-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberYM014777
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: