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General NPI Number Information
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NPI Number | 1811454523
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Entity Type | Individual
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Provider Name | MARY CAROLINE CORNELL
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Gender | Female
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 904 SCIOTO ST
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City | URBANA
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State | OH
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Zip | 43078-2226
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Country | US
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Telephone | 937-631-7419
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Fax |
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Provider Business Mailing Address
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Address Line | 1878 WILLOW LAKES DR
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City | SPRINGFIELD
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State | OH
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Zip | 45502-7305
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Country | US
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Telephone | 937-631-7418
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN.CNP.023843
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License Number State | OH
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