Provider Demographics
NPI:1104523885
Name:STUMP, KORIE LYNN
Entity type:Individual
Prefix:
First Name:KORIE
Middle Name:LYNN
Last Name:STUMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 N COUNTY ROAD 11
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-9436
Mailing Address - Country:US
Mailing Address - Phone:567-938-5323
Mailing Address - Fax:
Practice Address - Street 1:4119 N COUNTY ROAD 11
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-9436
Practice Address - Country:US
Practice Address - Phone:567-938-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No376K00000XNursing Service Related ProvidersNurse's Aide