1598958712 NPI number — NICOLE M CORRENTI MPT

Table of content: NICOLE M CORRENTI MPT (NPI 1598958712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598958712 NPI number — NICOLE M CORRENTI MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORRENTI
Provider First Name:
NICOLE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALVESTI
Provider Other First Name:
NICOLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598958712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 N ROCKTON AVE
Provider Second Line Business Mailing Address:
ATT. CHRIS LABONTE, RMH MED STAFF
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61103-3655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-971-2248
Provider Business Mailing Address Fax Number:
815-968-9340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 N ROCKTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61103-3619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-971-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2007

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: 225100000X , with the licence number:  070014649 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 070014649 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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