Provider Demographics
NPI:1639411010
Name:CORL, MAUREEN EGAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:EGAN
Last Name:CORL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT
Mailing Address - Street 2:2ND FLOOR, CBO 2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2609
Mailing Address - Country:US
Mailing Address - Phone:513-206-1170
Mailing Address - Fax:513-206-1172
Practice Address - Street 1:2123 AUBURN AVENUE
Practice Address - Street 2:SU. 139
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2609
Practice Address - Country:US
Practice Address - Phone:513-206-1170
Practice Address - Fax:513-206-1172
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-14066363L00000X
OH14066-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner