Provider Demographics
NPI:1508830563
Name:PACZKOWSKI, CORNELIA A (NP)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:A
Last Name:PACZKOWSKI
Suffix:
Gender:F
Credentials:NP
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 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16244 BENNETT RD
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4630
Practice Address - Country:US
Practice Address - Phone:540-825-5381
Practice Address - Fax:540-829-0945
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168011363LP0200X
NJNN47241363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508830563Medicaid
NJ8275807Medicaid