MEDICARE: LINSEY L KORNYA CPM

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	176B00000X	Midwife

General Provider Information

NPI Number	:	1558670190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINSEY L KORNYA CPM

Provider Business Mailing Address
First Line	:	4056 HUMPHREY ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-3823
Country	:	US
Telephone Number	:	314-677-9998
Fax Number	:

Provider Business Practice Location Address
First Line	:	4056 HUMPHREY ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-3823
Country	:	US
Telephone Number	:	314-677-9998
Fax Number	:

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

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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