Provider Demographics
NPI:1972565455
Name:CORNISH, CELESTE ANNE (RNFA)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:ANNE
Last Name:CORNISH
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3154
Mailing Address - Country:US
Mailing Address - Phone:843-388-0606
Mailing Address - Fax:843-388-0607
Practice Address - Street 1:887 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3154
Practice Address - Country:US
Practice Address - Phone:843-388-0606
Practice Address - Fax:843-388-0607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34576163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic