Healthcare Provider Details

I. General information

NPI: 1477675486
Provider Name (Legal Business Name): DENISE LYNN CORNELL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 ODDIE BLVD
SPARKS NV
89431-3559
US

IV. Provider business mailing address

780 KUENZLI ST SUITE 202
RENO NV
89502-0845
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5140
  • Fax: 775-982-5141
Mailing address:
  • Phone: 775-982-5966
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN00188
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAPN00188
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: