Provider Demographics
NPI:1083243745
Name:CORNISH, HEATHER COLLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:COLLEEN
Last Name:CORNISH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:COLLEEN
Other - Last Name:HANRAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:28 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1421
Mailing Address - Country:US
Mailing Address - Phone:607-661-2175
Mailing Address - Fax:
Practice Address - Street 1:28 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1421
Practice Address - Country:US
Practice Address - Phone:607-661-2175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY449458163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health