1104944131 NPI number — MS. ROXANNE CORELLO RNC FNP WHNP MSN MPH

Table of content: MS. ROXANNE CORELLO RNC FNP WHNP MSN MPH (NPI 1104944131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104944131 NPI number — MS. ROXANNE CORELLO RNC FNP WHNP MSN MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORELLO
Provider First Name:
ROXANNE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNC FNP WHNP MSN MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104944131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88361
Provider Second Line Business Mailing Address:
CITY OF HOUSTON HEALTH & HUMAN SERVICES
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77288-8861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-794-9104
Provider Business Mailing Address Fax Number:
713-798-0803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8523 ARKANSAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-696-5900
Provider Business Practice Location Address Fax Number:
713-694-4169
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  579900 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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