Provider Demographics
NPI:1285853655
Name:CORNELIUS, MARLA ELIZABETH (RD)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:ELIZABETH
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31538
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-1538
Mailing Address - Country:US
Mailing Address - Phone:561-329-8683
Mailing Address - Fax:
Practice Address - Street 1:120 SEA STEPPES CT
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-9680
Practice Address - Country:US
Practice Address - Phone:561-329-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 1700133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered