Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 401383 | NY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP5340 | AZ |
NPI | 1033432042 |
---|---|
Provider Name | Steven Korona |
First Address | Kingman, AZ 86409-3071 |
Second Address | Kingman, AZ 86409-3071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2010 |
Last Update Date | 28/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336163963 | (05) | NY |