Provider Demographics
NPI:1306150750
Name:CORBIN, JENNIFER MOSS (IBCLC, DOULA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MOSS
Last Name:CORBIN
Suffix:
Gender:F
Credentials:IBCLC, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 TABLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-6644
Mailing Address - Country:US
Mailing Address - Phone:704-540-2322
Mailing Address - Fax:
Practice Address - Street 1:3716 TABLE ROCK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-6644
Practice Address - Country:US
Practice Address - Phone:704-540-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
NC102-18003174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN