Katrina Corliss, MT
Individual provider Active NPI Medical Technologist · Ft Washacki, WY
NPI 1013383934 · NPPES record last updated Aug 14, 2015
Key facts
- NPI
- 1013383934
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Technologist 246QM0706X
- License
- AAB 2050187 (MI)
- Practice address
- 29 Black Coal Rd
Laboratory
Ft Washacki, WY 82514 - Phone
- (307) 335-5973
- Fax
- (307) 332-7514
- NPI assigned
- Aug 14, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AAB 2050187 | MI | MD | Medical Technologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Technologist | 246QM0706X | AAB 2050187 | MI | Yes |
Addresses
Primary practice location
29 Black Coal Rd
Laboratory
Ft Washacki, WY 82514
Mailing address
3223 E Stage Rd
Ionia, MI 48846-9718
Phone (307) 330-3012
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.