Provider Demographics
NPI:1184922346
Name:CORWIN, JUSTINE F (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:F
Last Name:CORWIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JUSTINE
Other - Middle Name:F
Other - Last Name:KERWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-7260
Mailing Address - Fax:410-328-1048
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:410-328-7260
Practice Address - Fax:410-328-1048
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0420OtherBC/BS REGIONAL
MD335524100Medicaid
MD973265-01OtherCAREFIRST BC/BS
DE1184922346Medicaid
MD973265-01OtherCAREFIRST BC/BS
MD335524100Medicaid