Provider Demographics
NPI:1215244793
Name:CORBIN, CARLIE G (CRNP)
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:G
Last Name:CORBIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:G
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:913 NW GARDEN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6523
Mailing Address - Country:US
Mailing Address - Phone:541-440-1257
Mailing Address - Fax:208-642-9598
Practice Address - Street 1:913 NW GARDEN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6523
Practice Address - Country:US
Practice Address - Phone:541-440-1257
Practice Address - Fax:541-440-1356
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1140-A363LP0808X
OR201150186NP364SP0809X
IDNP1140A364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNP-1140AOtherSTATE LICENSE
IDNP-1140AOtherSTATE LICENSE