Basic Information
Provider Information | |||||||||
NPI: | 1679831903 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CORSI | ||||||||
FirstName: | MARK | ||||||||
MiddleName: | JOSEPH | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 95 BAY VIEW AVE | ||||||||
Address2: |   | ||||||||
City: | CRANSTON | ||||||||
State: | RI | ||||||||
PostalCode: | 029054206 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4019416811 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2 OLD COUNTY RD | ||||||||
Address2: |   | ||||||||
City: | BARRINGTON | ||||||||
State: | RI | ||||||||
PostalCode: | 028061600 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4012461195 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/24/2012 | ||||||||
LastUpdateDate: | 04/24/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN35881 | RI | Y |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.