Provider Demographics
NPI:1023318144
Name:KORNELSON, LINDSAY RENE (ARNP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RENE
Last Name:KORNELSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9746 W US 2 HWY STE D
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9832
Mailing Address - Country:US
Mailing Address - Phone:509-598-7940
Mailing Address - Fax:
Practice Address - Street 1:9746 W US 2 HWY STE D
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9832
Practice Address - Country:US
Practice Address - Phone:509-598-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61336585363L00000X
KS75193207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner