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Individual

MRS. CORETTA STALLWORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP -C

Contact information

Practice address
3333 BURNET AVENUE, MLC 6015, CINCINNATI, OH 45229-3026
(513) 636-0800
(513) 803-0823
Mailing address
3333 BURNET AVENUE, MLC 6015, CINCINNATI, OH 45229-3026
(513) 636-0800
(513) 803-0823

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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