Provider Demographics
NPI:1578745279
Name:CORNELIUS, GILLIAN ELAINE (RNFA/CNOR)
Entity Type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:ELAINE
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:RNFA/CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9842 E BANKHEAD HWY
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-2651
Mailing Address - Country:US
Mailing Address - Phone:817-929-5097
Mailing Address - Fax:817-861-3003
Practice Address - Street 1:9842 E BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-2651
Practice Address - Country:US
Practice Address - Phone:817-929-5097
Practice Address - Fax:817-861-3003
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531645163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant