Individual
MRS. CORETTA STALLWORTH
Active
Individual
MRS. CORETTA STALLWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP -C
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN.CNP.15366
OH
363LF0000X
Family Nurse Practitioner
Primary
COA-15366-NP
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
COA 15366 NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0098923
—
OH
01
—
1073943106
NPI
OH
Enumeration date
11/27/2013
Last updated
11/17/2021
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