Healthcare Provider Details

I. General information

NPI: 1598170433
Provider Name (Legal Business Name): RACHEL L. CORNELLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 W BEN WHITE BLVD BLDG A, STE 100
AUSTIN TX
78704-7034
US

IV. Provider business mailing address

706 W BEN WHITE BLVD BLDG A, STE 100
AUSTIN TX
78704-7034
US

V. Phone/Fax

Practice location:
  • Phone: 512-442-1996
  • Fax: 512-441-1093
Mailing address:
  • Phone: 512-442-1996
  • Fax: 512-441-1093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: