Provider Demographics
NPI:1588663736
Name:CORLEY, REBECCA S (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N 5TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3080
Mailing Address - Country:US
Mailing Address - Phone:360-582-2840
Mailing Address - Fax:360-582-2846
Practice Address - Street 1:777 N 5TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3080
Practice Address - Country:US
Practice Address - Phone:360-582-2840
Practice Address - Fax:360-582-2846
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025209174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8130288Medicaid
WAC91207Medicare UPIN
WAGAB26999Medicare ID - Type Unspecified