Provider Demographics
NPI:1912982281
Name:COREY, MARY ROSE C (NP)
Entity Type:Individual
Prefix:
First Name:MARY ROSE
Middle Name:C
Last Name:COREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:OB/GYN, #2500, ACC
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6930
Mailing Address - Fax:916-734-6666
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:OB/GYN, #2500, ACC
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6930
Practice Address - Fax:916-734-6666
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP9562363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPP000Medicare UPIN