Provider Demographics
NPI:1871308700
Name:PRIEWE, COREY (PA)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:PRIEWE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 BALLTOWN RD APT 13
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1636
Mailing Address - Country:US
Mailing Address - Phone:407-970-8048
Mailing Address - Fax:
Practice Address - Street 1:188 BALLTOWN RD APT 13
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1636
Practice Address - Country:US
Practice Address - Phone:407-970-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program