Provider Demographics
NPI:1871351866
Name:HASTON, CORY LEE (FNP-C)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:LEE
Last Name:HASTON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:CORY
Other - Middle Name:
Other - Last Name:HUDGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-6099
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-6099
Practice Address - Country:US
Practice Address - Phone:219-886-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015021A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner