Healthcare Provider Details

I. General information

NPI: 1811722408
Provider Name (Legal Business Name): RACHEL KORBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MURRAY ST
DALLAS TX
75226-1645
US

IV. Provider business mailing address

10308 PAUL REVERE WAY
MCKINNEY TX
75072-5628
US

V. Phone/Fax

Practice location:
  • Phone: 469-608-0071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-133084
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: