Provider Demographics
NPI:1164987319
Name:CORLETT, MEGAN C (CCP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:CORLETT
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19915 GULF BLVD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:INDIAN SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2496
Mailing Address - Country:US
Mailing Address - Phone:303-842-2597
Mailing Address - Fax:
Practice Address - Street 1:45211 HELM ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6023
Practice Address - Country:US
Practice Address - Phone:734-525-9712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist