Provider Demographics
NPI:1942725825
Name:KORNELY, AMBER L (NP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:KORNELY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:L
Other - Last Name:THOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:F-NP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:1976 LIME KILN RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4417
Practice Address - Country:US
Practice Address - Phone:920-445-7377
Practice Address - Fax:920-592-9479
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7880-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2017003008OtherAMERICAN NURSES CREDENTIALING CENTER