Provider Demographics
NPI:1205063773
Name:CORNELL, HEIDI A (NP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:CORNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:A
Other - Last Name:VOIGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2350 MAPLE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4080
Mailing Address - Country:US
Mailing Address - Phone:716-688-6500
Mailing Address - Fax:716-688-6501
Practice Address - Street 1:2350 MAPLE RD
Practice Address - Street 2:STE 100
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-4080
Practice Address - Country:US
Practice Address - Phone:716-688-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305020363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY305020OtherLICENSE