Provider Demographics
NPI:1386329159
Name:MARK, CORINA ANETTE (PA)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:ANETTE
Last Name:MARK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:111 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2741
Mailing Address - Country:US
Mailing Address - Phone:218-739-6870
Mailing Address - Fax:218-739-6654
Practice Address - Street 1:111 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2741
Practice Address - Country:US
Practice Address - Phone:218-739-6870
Practice Address - Fax:218-739-6654
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2025-11-17
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Provider Licenses
StateLicense IDTaxonomies
MN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty