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General NPI Number Information
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NPI Number | 1508196312
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Entity Type | Individual
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Provider Name | LEONA WILHELMINA CAMPBELL CORBET FNP
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Gender | Female
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 50 ROUTE 25A
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City | SMITHTOWN
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State | NY
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Zip | 11787-1348
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Country | US
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Telephone | 631-862-3510
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Fax | 631-862-3802
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Provider Business Mailing Address
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Address Line | 344 POND PATH
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City | EAST SETAUKET
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State | NY
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Zip | 11733-1024
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Country | US
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Telephone | 631-751-1287
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 334104
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License Number State | NY
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