Healthcare Provider Details

I. General information

NPI: 1578126066
Provider Name (Legal Business Name): OKSANA VALERIYI KOROTUN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W SEMANDS ST
CONROE TX
77301-1867
US

IV. Provider business mailing address

59 N BROOKSEDGE CIR
THE WOODLANDS TX
77382-5733
US

V. Phone/Fax

Practice location:
  • Phone: 936-249-2244
  • Fax:
Mailing address:
  • Phone: 832-702-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number951023
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: