Provider Demographics
NPI:1992731541
Name:BASSETT, CORINNE (MD)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:BASSETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-907-6300
Mailing Address - Fax:509-907-6310
Practice Address - Street 1:5109 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-907-6300
Practice Address - Fax:509-907-6310
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA315457OtherL&I POST 7/21/13
WAP01287740OtherRR MEDICARE
WA66006OtherL&I
WA8304842Medicaid
WA8304842Medicaid
WAG8920314Medicare PIN
WAG8920314, G8920315Medicare PIN