Healthcare Provider Details

I. General information

NPI: 1285737486
Provider Name (Legal Business Name): DEBORAH JEAN CORNELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE UHC/DEPT PED-NEONATOLOGY RB&C 6010
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

1180 YELLOWSTONE RD
CLEVELAND HEIGHTS OH
44121-1554
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3266
  • Fax: 216-844-3380
Mailing address:
  • Phone: 216-291-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberNP-01427
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: