Individual
MS. JOCELYN J KORASICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
740 MCKINLEY AVE, KELLOGG, ID 83837-2693
(208) 783-1267
(844) 807-3782
Mailing address
PO BOX 1387, HAYDEN, ID 83835-1387
(208) 620-5250
(509) 755-6580
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
52099-20
WI
207Q00000X
Family Medicine Physician
Primary
M-15413
ID
207Q00000X
Family Medicine Physician
MD60470272
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457346603
—
ID
05
—
35370500
—
WI
Enumeration date
09/14/2005
Last updated
04/04/2023
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