Provider Demographics
NPI:1295298081
Name:REINHOLZ, CORINNE S (PA)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:S
Last Name:REINHOLZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:S
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6800 STATE ROUTE 162 # 215
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-8500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6812 STATE ROUTE 162 STE 120
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8586
Practice Address - Country:US
Practice Address - Phone:618-288-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant