Individual
JENNIFER CORPUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(800) 652-9221
Mailing address
26 RIVERSIDE DR NW, LUDOWICI, GA 31316-2365
(917) 929-1399
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
2013041593
MO
164W00000X
Licensed Practical Nurse
Primary
314973
NY
Other
Enumeration date
01/12/2016
Last updated
01/12/2016
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