Provider Demographics
NPI:1316404163
Name:CORNELIUS, JACQUELINE SUE (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUE
Last Name:CORNELIUS
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:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:NE
Mailing Address - Zip Code:68876-0610
Mailing Address - Country:US
Mailing Address - Phone:308-647-5459
Mailing Address - Fax:
Practice Address - Street 1:210 9TH ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:NE
Practice Address - Zip Code:68876-9639
Practice Address - Country:US
Practice Address - Phone:308-647-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE44436163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool