Provider Demographics
NPI:1902960073
Name:KORSHUKIN, EMMA L (WHCNP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:L
Last Name:KORSHUKIN
Suffix:
Gender:F
Credentials:WHCNP
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3320 LIVE OAK ST FL 5
Practice Address - Street 2:EAST DALLAS WOMEN'S HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6109
Practice Address - Country:US
Practice Address - Phone:214-266-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX591946363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196803403Medicaid
TX196803402Medicaid
TX196803404Medicaid
TX196803408Medicaid
TX196803401Medicaid
TX196803406Medicaid
TX196803405Medicaid
TX196803409Medicaid
TX103311004Medicaid
TX196803407Medicaid
TX196803410Medicaid
TX8Y3533OtherBLUE CROSS BLUE SHIELD