Healthcare Provider Details

I. General information

NPI: 1609857507
Provider Name (Legal Business Name): CLARE H. CORNELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 HAYMAKER RD
MONROEVILLE PA
15146-3517
US

IV. Provider business mailing address

7412 RICHLAND PL
PITTSBURGH PA
15208-2734
US

V. Phone/Fax

Practice location:
  • Phone: 412-858-2760
  • Fax: 412-858-2765
Mailing address:
  • Phone: 412-242-6928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberVP000712B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: