Basic Information
| Provider Information | |||||||||
| NPI: | 1558648576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INGLE | ||||||||
| FirstName: | CORINNE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2858 SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036999073 | ||||||||
| FaxNumber: | 8037642361 | ||||||||
| Practice Location | |||||||||
| Address1: | 2858 SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036999073 | ||||||||
| FaxNumber: | 8665270937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2011 | ||||||||
| LastUpdateDate: | 07/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 5005404 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.