Healthcare Provider Details

I. General information

NPI: 1811271398
Provider Name (Legal Business Name): PATRICIA A CORNELL A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 PARK LN
ITHACA NY
14850-6309
US

IV. Provider business mailing address

953 DANBY RD HAMMOND HEALTH CENTER AT ITHACA COLLEGE
ITHACA NY
14850-7000
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-3054
  • Fax:
Mailing address:
  • Phone: 607-274-3177
  • Fax: 607-274-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF300622-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: