Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R214668 | MD |
NPI | 1023590098 |
---|---|
Provider Name | Emily Korenchuk |
First Address | Kensington, MD 20895-3654 |
Second Address | Baltimore, MD 21201-3610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 16/10/2019 |