Renee A Cork, ATC
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Willaimsburg, VA
NPI 1710184809 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1710184809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- 0126000453 (VA)
- Practice address
- 751 Ukrops Dr
Willaimsburg, VA 23185 - Phone
- (757) 221-3347
- Fax
- (757) 221-3412
- NPI assigned
- Jul 2, 2007
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0126000453 | VA | MD | Student in an Organized Health Care Education/Training Program |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 0126000453 | VA | Yes |
Addresses
Primary practice location
751 Ukrops Dr
Willaimsburg, VA 23185
Mailing address
PO Box 399
Williamsburg, VA 23187-0399
Phone (757) 221-3347
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.