Doctor Name: | ROBERTA L. KORICH |
NPI Number: | 1053496315 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | F330751 |
Business Practice Address: | 367 E Main St Seneca Family Health Center Waterloo, NY - 131651643 |
Business Phone Number: | 3157874977 |
Business Fax Number: | |
Mailing Address: | 442 Billsboro Rd, GENEVA |
State: | NY |
Postal Code: | 144569782 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/26/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | F330751 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |