Provider Demographics
NPI:1407052731
Name:CORLEY, MARY JO (RN,BSN,MAC,RAC,DIP)
Entity Type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:CORLEY
Suffix:
Gender:F
Credentials:RN,BSN,MAC,RAC,DIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-7155
Mailing Address - Country:US
Mailing Address - Phone:610-490-0569
Mailing Address - Fax:
Practice Address - Street 1:517 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-4038
Practice Address - Country:US
Practice Address - Phone:610-565-4947
Practice Address - Fax:610-565-4957
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000794171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist