Provider Demographics
NPI:1255048286
Name:CORNELIUS, LAUREN N
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:N
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 N DIXIE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2536
Mailing Address - Country:US
Mailing Address - Phone:270-266-2391
Mailing Address - Fax:270-266-6032
Practice Address - Street 1:914 N DIXIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2536
Practice Address - Country:US
Practice Address - Phone:270-266-2391
Practice Address - Fax:270-266-6032
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator