Healthcare Provider Details

I. General information

NPI: 1972897692
Provider Name (Legal Business Name): MARYELLEN ELIZABETH CORBEIL CPM, LM, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 NEWTON AVE S
MINNEAPOLIS MN
55405-2036
US

IV. Provider business mailing address

32 NEWTON AVE S
MINNEAPOLIS MN
55405-2036
US

V. Phone/Fax

Practice location:
  • Phone: 612-381-1270
  • Fax:
Mailing address:
  • Phone: 612-381-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1031
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: