Provider Demographics
NPI:1174559611
Name:DARGUS, CORINNE A (PAC)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:A
Last Name:DARGUS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-0506
Mailing Address - Country:US
Mailing Address - Phone:218-435-1212
Mailing Address - Fax:218-435-1302
Practice Address - Street 1:102 SATHER DR
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1531
Practice Address - Country:US
Practice Address - Phone:218-435-1212
Practice Address - Fax:218-435-1302
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNDA9071015605OtherPREFERRED ONE #
MNHP25733OtherHEALTHPARTNERS #
MN0111355OtherMEDICA #
MN18689OtherNDBS #
MN4F107DAOtherMNBS #
MN974761OtherAMERICA'S PPO/ARAZ #
MN142331OtherUCARE #
MNDA9071015605OtherPREFERRED ONE #