Provider Demographics
NPI:1245038314
Name:CORNELIUS, SIBYLLE RIPPER
Entity type:Individual
Prefix:
First Name:SIBYLLE
Middle Name:RIPPER
Last Name:CORNELIUS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6360
Mailing Address - Country:US
Mailing Address - Phone:478-719-6968
Mailing Address - Fax:
Practice Address - Street 1:101 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6360
Practice Address - Country:US
Practice Address - Phone:478-719-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN095876164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty