Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R164292 | MD |
NPI | 1003357211 |
---|---|
Provider Name | Wendy Corkran |
First Address | Parsonsburg, MD 21849-2506 |
Second Address | Delmar, DE 19940-1115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2017 |
Last Update Date | 20/03/2017 |