Provider Demographics
NPI:1821324039
Name:CORLEY, CAROL ANN (RN NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:CORLEY
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:363 MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1729
Mailing Address - Country:US
Mailing Address - Phone:650-306-9490
Mailing Address - Fax:650-306-9355
Practice Address - Street 1:363 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1729
Practice Address - Country:US
Practice Address - Phone:650-306-9490
Practice Address - Fax:650-306-9355
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner