Provider Demographics
NPI:1699763409
Name:CORBETT, PATRICIA ANN (NP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:CORBETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:1708 HIGH ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-2633
Practice Address - Country:US
Practice Address - Phone:574-400-4418
Practice Address - Fax:574-232-9550
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001141A363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000789430OtherBCBS CENTENNIAL
IN000000365101OtherBCBS BMG CENTRAL
IN200044860Medicaid
IN500029743OtherRR MEDICARE
IN500029743OtherRR MEDICARE
IN178420IMedicare PIN
IN200044860Medicaid
IN000000789430OtherBCBS CENTENNIAL