Provider Demographics
NPI:1407326895
Name:CORNELL, TAYLER ROCHELLE (RN)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:ROCHELLE
Last Name:CORNELL
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 1:20150 XEON AVE
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-9362
Mailing Address - Country:US
Mailing Address - Phone:319-601-1065
Mailing Address - Fax:
Practice Address - Street 1:20150 XEON AVE
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-9362
Practice Address - Country:US
Practice Address - Phone:319-601-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2468888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse