Provider Demographics
NPI:1124796859
Name:LAKOMSKI, CORRIN HELEN (NP-C)
Entity type:Individual
Prefix:
First Name:CORRIN
Middle Name:HELEN
Last Name:LAKOMSKI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CORRIN
Other - Middle Name:HELEN
Other - Last Name:GRAVATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10547 W SWAYBACK PASS
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5761
Mailing Address - Country:US
Mailing Address - Phone:623-824-2622
Mailing Address - Fax:
Practice Address - Street 1:10547 W SWAYBACK PASS
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-5761
Practice Address - Country:US
Practice Address - Phone:623-824-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily