Healthcare Provider Details

I. General information

NPI: 1851785216
Provider Name (Legal Business Name): COROLLA HEALTH PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 13TH AVE E SUITE 6
HIBBING MN
55746-3675
US

IV. Provider business mailing address

PO BOX 352
MOUNTAIN IRON MN
55768-0352
US

V. Phone/Fax

Practice location:
  • Phone: 218-312-1225
  • Fax: 888-680-4314
Mailing address:
  • Phone: 218-312-1225
  • Fax: 888-680-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CHANDRA WHITE
Title or Position: OWNER
Credential:
Phone: 218-312-1225