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General NPI Number Information
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NPI Number | 1316963911
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Entity Type | Individual
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Provider Name | MARY-ELIZABETH CORDLE NP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 4509 GIBSON ROAD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564
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Country | US
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Telephone | 228-892-3993
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Fax | 228-872-3992
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Provider Business Mailing Address
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Address Line | 4509 GIBSON ROAD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564
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Country | US
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Telephone | 228-892-3993
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Fax | 228-872-3992
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 894998
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 894998
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License Number State | MS
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