Provider Demographics
NPI:1851704878
Name:CORBELLO, MARY ELIZABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:CORBELLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:CORBELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 122205 DEPT 2205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:4345 NELSON RD. STE. 201
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-494-6800
Practice Address - Fax:337-494-6811
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily