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General NPI Number Information
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NPI Number | 1275426280
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Entity Type | Individual
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Provider Name | JANETTA CORNELISON
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Gender | Female
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 8921 S MINGO RD
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City | TULSA
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State | OK
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Zip | 74133-5841
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Country | US
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Telephone | 918-252-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 4605 S 289TH WEST AVE
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City | MANNFORD
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State | OK
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Zip | 74044-3088
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Country | US
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Telephone | 918-504-5549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | R0084962
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License Number State | OK
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