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NPI Code Detail

MEDICARE: JOLINE M. CORNELL CRNA

MEDICARE: JOLINE M. CORNELL CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist03796-NAOH
2367500000XCertified Registered Nurse Anesthetist28171228AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000506889OTHERINANTHEM PROVIDER NUMBER
29334559OTHERINPHCS PID NUMBER

General Provider Information

NPI Number : 1821060989
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOLINE M. CORNELL CRNA
Provider Business Mailing Address
First Line : PO BOX 5545
Second Line :
City : LAFAYETTE
State : IN
Zip : 47903-5545
Country : US
Telephone Number : 765-448-8000
Fax Number : 765-448-8335
Provider Business Practice Location Address
First Line : 2600 GREENBUSH STREET
Second Line :
City : LAFAYETTE
State : IN
Zip : 47904-2479
Country : US
Telephone Number : 765-448-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 02/08/2008

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