Provider Demographics
NPI:1871627828
Name:LENTS, CORINNE MARIA (PA-C)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:MARIA
Last Name:LENTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9921 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3767
Mailing Address - Country:US
Mailing Address - Phone:708-499-5678
Mailing Address - Fax:
Practice Address - Street 1:327 W SCHILLER ST
Practice Address - Street 2:C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1827
Practice Address - Country:US
Practice Address - Phone:949-395-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002574363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant