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NPI Code Detail

MEDICARE: PAMELA S CORNWELL NP

MEDICARE: PAMELA S CORNWELL NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71010035AIN
2363LF0000XFamily Nurse Practitioner28150677AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558753152
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA S CORNWELL NP
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7411 HOPE DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-5687
Country : US
Telephone Number : 260-264-5600
Fax Number : 260-444-2082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2015
Last Update Date : 04/04/2022

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Directions to “ PAMELA S CORNWELL NP” Practice Location

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