MEDICARE: MS. DENISE ANN CORBAT FNP

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	163WC0400X	Case Management Registered Nurse	4704164239	MI
2	363LF0000X	Family Nurse Practitioner	4704164239	MI

General Provider Information

NPI Number	:	1386232171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE ANN CORBAT FNP

Provider Business Mailing Address
First Line	:	411 OTT RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9429
Country	:	US
Telephone Number	:	989-781-4068
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 OTT RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9429
Country	:	US
Telephone Number	:	989-714-0686
Fax Number	:

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

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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