Provider Demographics
NPI:1679809560
Name:CORNELLA, KARI
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:CORNELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 STATE HIGHWAY 93
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-9204
Mailing Address - Country:US
Mailing Address - Phone:307-237-9146
Mailing Address - Fax:307-234-1029
Practice Address - Street 1:345 N WALSH DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-1941
Practice Address - Country:US
Practice Address - Phone:307-237-9146
Practice Address - Fax:307-234-1029
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator