Provider Demographics
NPI:1851804694
Name:CORNELIS, LAURA JEAN (APN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:CORNELIS
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:DEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:
Practice Address - Street 1:485 WILLIAMSTOWN RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1777
Practice Address - Country:US
Practice Address - Phone:856-237-8100
Practice Address - Fax:856-237-8042
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00780000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily