Provider Demographics
NPI:1992234678
Name:NULTON, CORINNE NICOLE (DO)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:NICOLE
Last Name:NULTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD STE 464
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3740
Mailing Address - Country:US
Mailing Address - Phone:412-267-6360
Mailing Address - Fax:
Practice Address - Street 1:575 COAL VALLEY RD STE 464
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3740
Practice Address - Country:US
Practice Address - Phone:412-267-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0212882084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
15607852OtherCAQH