Provider Demographics
NPI:1942933239
Name:KORNELLY, ALLISON PAIGE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:PAIGE
Last Name:KORNELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:WI
Mailing Address - Zip Code:54208-9459
Mailing Address - Country:US
Mailing Address - Phone:920-664-2344
Mailing Address - Fax:
Practice Address - Street 1:5437 NORTH AVE
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:WI
Practice Address - Zip Code:54208-9459
Practice Address - Country:US
Practice Address - Phone:920-664-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program