Provider Demographics
NPI:1205153582
Name:CORNEAL, JENNIFER N (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:N
Last Name:CORNEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 CEDAR BEND CT
Mailing Address - Street 2:#B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-5333
Mailing Address - Country:US
Mailing Address - Phone:502-718-6667
Mailing Address - Fax:
Practice Address - Street 1:6521 CEDAR BEND CT
Practice Address - Street 2:#B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5333
Practice Address - Country:US
Practice Address - Phone:502-718-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program