Provider Demographics
NPI:1699002709
Name:CORNELL, DENISE MARY (APN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARY
Last Name:CORNELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 COUNTY ROAD 150 E
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:IL
Mailing Address - Zip Code:61491-9615
Mailing Address - Country:US
Mailing Address - Phone:309-493-5891
Mailing Address - Fax:
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-655-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007863363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care