Provider Demographics
NPI:1972897692
Name:CORBEIL, MARYELLEN ELIZABETH (CPM, LM, CD(DONA))
Entity Type:Individual
Prefix:MS
First Name:MARYELLEN
Middle Name:ELIZABETH
Last Name:CORBEIL
Suffix:
Gender:F
Credentials:CPM, LM, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 NEWTON AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2036
Mailing Address - Country:US
Mailing Address - Phone:612-381-1270
Mailing Address - Fax:
Practice Address - Street 1:32 NEWTON AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2036
Practice Address - Country:US
Practice Address - Phone:612-381-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1031176B00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula