Provider Demographics
NPI:1659047074
Name:CORBIN, LISA RENA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENA
Last Name:CORBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:RENA
Other - Last Name:MCKINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1580 CROSSWAYS BLVD 103 SUITE 12
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2031
Mailing Address - Country:US
Mailing Address - Phone:757-567-2698
Mailing Address - Fax:
Practice Address - Street 1:1580 CROSSWAYS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0206
Practice Address - Country:US
Practice Address - Phone:757-567-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1201092084174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist