MEDICARE: PATRICIA LYNN CORRAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN151599L	PA
2	156F00000X	Technician/Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000	OTHER	PA	01

General Provider Information

NPI Number	:	1144788589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LYNN CORRAO

Provider Business Mailing Address
First Line	:	5 CANDLEWYCK CT
Second Line	:
City	:	WILLOW STREET
State	:	PA
Zip	:	17584-9019
Country	:	US
Telephone Number	:	717-615-3558
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 WILLOW VALLEY LAKES DR
Second Line	:
City	:	WILLOW STREET
State	:	PA
Zip	:	17584-9668
Country	:	US
Telephone Number	:	717-740-4434
Fax Number	:	717-740-4451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	07/17/2023

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