Provider Demographics
NPI:1972908838
Name:ROANE, KORINNE (NP)
Entity type:Individual
Prefix:MS
First Name:KORINNE
Middle Name:
Last Name:ROANE
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 1:1 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1875
Mailing Address - Country:US
Mailing Address - Phone:609-567-0434
Mailing Address - Fax:609-567-1169
Practice Address - Street 1:238 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1108
Practice Address - Country:US
Practice Address - Phone:856-935-7711
Practice Address - Fax:856-935-9123
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00542500363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0459496Medicaid
NJ403501N4XMedicare PIN