Healthcare Provider Details

I. General information

NPI: 1902454812
Provider Name (Legal Business Name): ALYSSA NICOLE CORNEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N MORRISON RD
MUNCIE IN
47304-5568
US

IV. Provider business mailing address

11854 HIGHLINE CT
NOBLESVILLE IN
46060-9408
US

V. Phone/Fax

Practice location:
  • Phone: 765-254-5602
  • Fax:
Mailing address:
  • Phone: 317-753-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26027228A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: