Provider Demographics
NPI:1548930696
Name:KANTOR, CORINNE MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:MICHELLE
Last Name:KANTOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9804 SAGE CT
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-8562
Mailing Address - Country:US
Mailing Address - Phone:847-682-1029
Mailing Address - Fax:
Practice Address - Street 1:9804 SAGE CT
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-8562
Practice Address - Country:US
Practice Address - Phone:847-682-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041363517163W00000X
IL209028242367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse