Provider Demographics
NPI:1811552029
Name:CORNELL, GEORGEANNE EMERSON (DO)
Entity Type:Individual
Prefix:MRS
First Name:GEORGEANNE
Middle Name:EMERSON
Last Name:CORNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:GEORGEANNE
Other - Middle Name:EMEROSN
Other - Last Name:ZITSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 NW KESSLER DR APT 203
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-4171
Mailing Address - Country:US
Mailing Address - Phone:573-864-2730
Mailing Address - Fax:
Practice Address - Street 1:2301 HOLMES STREET
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-404-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2020022923208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice