Provider Demographics
NPI:1972806941
Name:KORSHAK, EVE BAGG (NP)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:BAGG
Last Name:KORSHAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:ELIZABETH
Other - Last Name:BAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 CAMINO ENCINAS
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563
Mailing Address - Country:US
Mailing Address - Phone:925-962-6603
Mailing Address - Fax:925-284-5662
Practice Address - Street 1:12 CAMINO ENCINAS
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563
Practice Address - Country:US
Practice Address - Phone:925-962-6603
Practice Address - Fax:925-284-5662
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily