Provider Demographics
NPI:1619135332
Name:CORNELL, JANELLE JOYCE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:JOYCE
Last Name:CORNELL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1562
Mailing Address - Country:US
Mailing Address - Phone:217-824-1840
Mailing Address - Fax:217-824-1814
Practice Address - Street 1:201 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1562
Practice Address - Country:US
Practice Address - Phone:217-824-1840
Practice Address - Fax:217-824-1814
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.002454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04527Medicare UPIN