Provider Demographics
NPI:1275196859
Name:CORNETTE, PERLA (RN)
Entity Type:Individual
Prefix:MRS
First Name:PERLA
Middle Name:
Last Name:CORNETTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21311 41ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-6719
Mailing Address - Country:US
Mailing Address - Phone:253-732-8910
Mailing Address - Fax:
Practice Address - Street 1:9059 GARDNER LOOP WTB MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-967-5603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00111898163W00000X
WAWA00111898163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR085896OtherRN LICENSE
WARN00111898OtherRN