Provider Demographics
NPI:1447668595
Name:CORN, TINA MARIE (RDMS(OB/GYN,AB), RVT)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:CORN
Suffix:
Gender:F
Credentials:RDMS(OB/GYN,AB), RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HALLIBURTON RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3816
Mailing Address - Country:US
Mailing Address - Phone:828-779-2746
Mailing Address - Fax:
Practice Address - Street 1:118 HALLIBURTON RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3816
Practice Address - Country:US
Practice Address - Phone:828-779-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1746302471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography