Most Relevant Information
Provider Data
| NPI Number: | 1003463951 |
| Provider Name: | CORENE KIMBERLY IRVIN APRN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | 60978206 |
Most Important Dates
| Enumeration Date: | 08/23/2019 |
| Last Updated: | 11/01/2021 |
Provider Practice Location
15508 80TH AVENUE CT E
PUYALLUP
WA
983758489
Practice Location Phone/Fax
| Phone: | 7856300608 |
| Fax: |
Provider Mailing Location
15508 80TH AVENUE CT E
PUYALLUP
WA
983758489
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |