Provider Demographics
NPI:1366103251
Name:CORBIN, AUBREY CAMILLE (LPN)
Entity type:Individual
Prefix:MISS
First Name:AUBREY
Middle Name:CAMILLE
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 EAGLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:OH
Mailing Address - Zip Code:45153-9665
Mailing Address - Country:US
Mailing Address - Phone:513-289-0311
Mailing Address - Fax:
Practice Address - Street 1:202 EAGLE POINT DR
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:OH
Practice Address - Zip Code:45153-9665
Practice Address - Country:US
Practice Address - Phone:513-289-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122135164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH122135Medicaid