Provider Demographics
NPI:1104594407
Name:KORB, JOSHUA MICHAEL (APRN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:KORB
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLE
Mailing Address - State:VT
Mailing Address - Zip Code:05458-2563
Mailing Address - Country:US
Mailing Address - Phone:925-997-1251
Mailing Address - Fax:
Practice Address - Street 1:154 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1399
Practice Address - Country:US
Practice Address - Phone:518-563-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH086162-23363LA2100X
NYF433099-01363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care