Provider Demographics
NPI:1548924525
Name:CORL, MARY J (RNJ)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:CORL
Suffix:
Gender:F
Credentials:RNJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 PEBBLEBROOK
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4378
Mailing Address - Country:US
Mailing Address - Phone:440-376-6654
Mailing Address - Fax:
Practice Address - Street 1:2214 PEBBLEBROOK
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4378
Practice Address - Country:US
Practice Address - Phone:440-376-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.179640163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice