Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | L9154 | TX |
NPI | 1003847674 |
---|---|
Provider Name | Dena L Cornelius |
First Address | Amarillo, TX 79159-0667 |
Second Address | Fort Worth, TX 76109-4415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 05/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
168273401 | (05) | TX |
I16777 | (02) | TX |