Provider Demographics
NPI:1083221675
Name:CORNELIUS, BRETT WILLIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:WILLIAM
Last Name:CORNELIUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:450 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-2200
Mailing Address - Country:US
Mailing Address - Phone:148-734-1618
Mailing Address - Fax:148-734-3102
Practice Address - Street 1:450 ERIE ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-2200
Practice Address - Country:US
Practice Address - Phone:148-734-1618
Practice Address - Fax:148-734-3102
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2022-01-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant