Provider Demographics
NPI:1265575203
Name:CORNELIUS, DAVID EMROY (RN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EMROY
Last Name:CORNELIUS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:HASKELL HEALTH CENTER 2415 MASSACHESETTS
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046
Mailing Address - Country:US
Mailing Address - Phone:785-843-3750
Mailing Address - Fax:785-832-4887
Practice Address - Street 1:2415 MASSACHESETTS
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046
Practice Address - Country:US
Practice Address - Phone:785-843-3750
Practice Address - Fax:785-832-4887
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-80991-042163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care