Provider Demographics
NPI:1093852501
Name:CORNELIUS, DAVID WESLEY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WESLEY
Last Name:CORNELIUS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 S 81ST WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-8276
Mailing Address - Country:US
Mailing Address - Phone:918-619-6444
Mailing Address - Fax:
Practice Address - Street 1:4630 S 81ST WEST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-8276
Practice Address - Country:US
Practice Address - Phone:918-619-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-RN RO34209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner