Provider Demographics
NPI:1376923607
Name:CORLETT, JEANETTE EILEEN (CNM)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:EILEEN
Last Name:CORLETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PARK WEST BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4215
Mailing Address - Country:US
Mailing Address - Phone:330-869-9777
Mailing Address - Fax:
Practice Address - Street 1:51 PARK WEST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4215
Practice Address - Country:US
Practice Address - Phone:330-869-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00057700367A00000X
OHCOA.19014-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife