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Individual
MR. DEREK BRENT KORDENBROCK
Active
Individual
MR. DEREK BRENT KORDENBROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
201604376NP-PP
OR
363LA2200X
Adult Health Nurse Practitioner
22446
CA
363LX0106X
Occupational Health Nurse Practitioner
201604376NP-PP
OR
363LX0106X
Occupational Health Nurse Practitioner
22446
CA
Other
Enumeration date
02/07/2013
Last updated
03/20/2023
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