Healthcare Provider Details

I. General information

NPI: 1194774240
Provider Name (Legal Business Name): SUSAN TUOMI CORNWELL CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 JUNCTION ROAD
MADISON WI
53717
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6420
  • Fax: 608-265-8065
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number67069
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: