Provider Demographics
NPI:1851704878
Name:CORBELLO, MARY ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:CORBELLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:CORBELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:701 CYPRESS ST
Mailing Address - Street 2:CLINIC ADMINISTRATION
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5053
Mailing Address - Country:US
Mailing Address - Phone:337-527-6530
Mailing Address - Fax:337-527-7337
Practice Address - Street 1:1629 BEGLIS PKWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5906
Practice Address - Country:US
Practice Address - Phone:337-439-2040
Practice Address - Fax:337-439-2014
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily