Provider Demographics
NPI:1366280190
Name:CORLETO, LILY ANN ROSETE (ARNP)
Entity type:Individual
Prefix:
First Name:LILY ANN
Middle Name:ROSETE
Last Name:CORLETO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-627-2983
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:900 STEVENS DR STE 101
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3536
Practice Address - Country:US
Practice Address - Phone:509-942-3163
Practice Address - Fax:509-943-5922
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61572066363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner