Basic Information
| Provider Information | |||||||||
| NPI: | 1053487587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORUZZI | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WISE | ||||||||
| OtherFirstName: | MARILYN | ||||||||
| OtherMiddleName: | CORUZZI | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 209 MOLLER AVE | ||||||||
| Address2: | SITKA COMMUNITY HOSPITAL | ||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998357142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074741722 | ||||||||
| FaxNumber: | 9077471755 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 MOLLER AVE | ||||||||
| Address2: | SITKA COMMUNITY HOSPITAL | ||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998357142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074741722 | ||||||||
| FaxNumber: | 9077471755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2006 | ||||||||
| LastUpdateDate: | 01/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 3781 | AK | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD37811 | 05 | AK | MEDICAID |