Provider Demographics
NPI:1750433801
Name:CORLEY, ETHEL ROBERTS (RN)
Entity type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:ROBERTS
Last Name:CORLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10836 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4771
Mailing Address - Country:US
Mailing Address - Phone:480-905-0391
Mailing Address - Fax:
Practice Address - Street 1:6615 E CHOLLA ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5039
Practice Address - Country:US
Practice Address - Phone:480-484-4411
Practice Address - Fax:480-484-4401
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN069399163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ882937OtherAHCCCS