Provider Demographics
NPI:1689050981
Name:OLIUS, CORNESHA (LPN)
Entity Type:Individual
Prefix:
First Name:CORNESHA
Middle Name:
Last Name:OLIUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 DRYDEN DR
Mailing Address - Street 2:312
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2802 DRYDEN DR
Practice Address - Street 2:312
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3118
Practice Address - Country:US
Practice Address - Phone:608-886-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319361-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse