Healthcare Provider Details

I. General information

NPI: 1265511448
Provider Name (Legal Business Name): CYNTHIA RAE CORNELL MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE SUITE 106
PHOENIX AZ
85027
US

IV. Provider business mailing address

13430 N SCOTTSDALE RD STE 200
SCOTTSDALE AZ
85254-4058
US

V. Phone/Fax

Practice location:
  • Phone: 623-516-8252
  • Fax: 623-516-8253
Mailing address:
  • Phone: 623-334-4000
  • Fax: 623-334-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN097577
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2610
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: