Provider Demographics
NPI:1033662770
Name:CORLE, MICHELLE LEE (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:CORLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-0384
Mailing Address - Country:US
Mailing Address - Phone:814-467-3637
Mailing Address - Fax:814-467-3622
Practice Address - Street 1:1511 SCALP AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904
Practice Address - Country:US
Practice Address - Phone:814-254-4207
Practice Address - Fax:814-254-4733
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034749420001Medicaid