Provider Demographics
NPI:1568925998
Name:CORNELIUS, VICTORIA MARI (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARI
Last Name:CORNELIUS
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 1:11690 TIMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3489
Mailing Address - Country:US
Mailing Address - Phone:804-982-7135
Mailing Address - Fax:
Practice Address - Street 1:11690 TIMBERLY CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-3489
Practice Address - Country:US
Practice Address - Phone:804-982-7135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177403363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology