Provider Demographics
NPI:1245665611
Name:ROWLAND, COREY
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:
Last Name:ROWLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S.125TH EAST. AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128
Mailing Address - Country:US
Mailing Address - Phone:313-461-0053
Mailing Address - Fax:
Practice Address - Street 1:1601 S 125TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-6017
Practice Address - Country:US
Practice Address - Phone:313-461-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator