| NPI | 1649898941 | 
|---|---|
| Former Name | REBA D CORLEY | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11015315) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA 214177) | 
| Enumeration Date | 2020-07-13 | 
| Last Update Date | 2022-02-08 |