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Individual

MR. DEREK BRENT KORDENBROCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
1345 CENTER DR UNIT A, MEDFORD, OR 97501-7945
(541) 734-9030
(541) 734-9885
Mailing address
815 N CENTRAL AVE STE C, MEDFORD, OR 97501-5873
(541) 734-9030
(541) 734-9885

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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