Provider Demographics
NPI:1114708567
Name:CORNELIUS, LAURIE J
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6118
Mailing Address - Country:US
Mailing Address - Phone:740-751-5023
Mailing Address - Fax:
Practice Address - Street 1:670 WOODROW AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6118
Practice Address - Country:US
Practice Address - Phone:740-751-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider