Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH0005942 | FL |
NPI | 1336156173 |
---|---|
Provider Name | Dr. Laura R Korman |
First Address | Port Charlotte, FL 33954-1674 |
Second Address | Port Charlotte, FL 33954-1674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 17/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22466 | BLUE CROSS/BLUE SHIELD (01) | FL |
380931500 | (05) | FL |
U21678 | (02) | FL |