Provider Demographics
NPI:1609355122
Name:CORKILL, JENELLE MARJORIE NICOLE (ND)
Entity Type:Individual
Prefix:MS
First Name:JENELLE
Middle Name:MARJORIE NICOLE
Last Name:CORKILL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2851 N TENAYA WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0453
Mailing Address - Country:US
Mailing Address - Phone:702-658-0204
Mailing Address - Fax:702-309-4879
Practice Address - Street 1:2440 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2731
Practice Address - Country:US
Practice Address - Phone:702-450-7175
Practice Address - Fax:702-436-6561
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath