Healthcare Provider Details

I. General information

NPI: 1922863539
Provider Name (Legal Business Name): MARISA ANN CORLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. ARMY HEALTH CLINIC STUTTGART UNIT 30401 PATCH BARRACKS GERMANY
STUTTGART BADEN-WURTEMBURG
09107
DE

IV. Provider business mailing address

CMR 480 BOX 1813
APO AE
09128-0019
US

V. Phone/Fax

Practice location:
  • Phone: 314-430-7990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number641409
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: