Provider Demographics
NPI:1558138834
Name:CORNELSON, LAURA ANNE (MSN, RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:CORNELSON
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6513 CASCADA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8154
Mailing Address - Country:US
Mailing Address - Phone:512-468-9765
Mailing Address - Fax:
Practice Address - Street 1:6513 CASCADA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8154
Practice Address - Country:US
Practice Address - Phone:512-468-9765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX632462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse