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General NPI Number Information
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NPI Number | 1538259130
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Entity Type | Individual
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Provider Name | RINA MELANIE CORSON MD
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 389 S 900 E INSTACARE
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-2310
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Country | US
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Telephone | 385-282-2400
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Fax | 385-282-2401
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Provider Business Mailing Address
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Address Line | 389 S 900 E INSTACARE
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-2310
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Country | US
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Telephone | 385-282-2400
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Fax | 385-282-2401
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5210788-1205
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License Number State | UT
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