Provider Demographics
NPI:1700351764
Name:CORNELIUS, LAURA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:CORNELIUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:489 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4853
Mailing Address - Country:US
Mailing Address - Phone:740-360-3603
Mailing Address - Fax:740-387-4059
Practice Address - Street 1:333 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4142
Practice Address - Country:US
Practice Address - Phone:740-375-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.168973.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse