Provider Demographics
NPI:1710261706
Name:CORNELIUS, LAURA OPAL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:OPAL
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 BURT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1598
Mailing Address - Country:US
Mailing Address - Phone:402-965-4004
Mailing Address - Fax:402-965-4232
Practice Address - Street 1:11920 BURT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1598
Practice Address - Country:US
Practice Address - Phone:402-965-4004
Practice Address - Fax:402-965-4232
Is Sole Proprietor?:No
Enumeration Date:2011-10-08
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111310363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health