Provider Demographics
NPI:1558121061
Name:CORLEY, AMANDA C
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:CORLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13543 WOODBINE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2617
Mailing Address - Country:US
Mailing Address - Phone:313-910-3764
Mailing Address - Fax:
Practice Address - Street 1:36855 MCKINNEY AVE APT 102
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1384
Practice Address - Country:US
Practice Address - Phone:313-910-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide