Healthcare Provider Details

I. General information

NPI: 1366017618
Provider Name (Legal Business Name): BARBARA KORCZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W ROSE ST
WALLA WALLA WA
99362-1662
US

IV. Provider business mailing address

1120 W ROSE ST
WALLA WALLA WA
99362-1662
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-6650
  • Fax:
Mailing address:
  • Phone: 509-525-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61574506
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: