Provider Demographics
NPI:1508425620
Name:CORNELL, ALICIA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:M
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 1:27 FIFTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TIOGA CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13845
Mailing Address - Country:US
Mailing Address - Phone:607-687-8002
Mailing Address - Fax:607-687-6945
Practice Address - Street 1:27 FIFTH AVENUE
Practice Address - Street 2:
Practice Address - City:TIOGA CENTER
Practice Address - State:NY
Practice Address - Zip Code:13845
Practice Address - Country:US
Practice Address - Phone:607-687-8002
Practice Address - Fax:607-687-6945
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659485163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool