Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 89710 | OK |
N | 363LG0600X | Nurse Practitioner - Gerontology | 89710 | OK |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 89710 | OK |
NPI | 1003296492 |
---|---|
Provider Name | Dr. Nicole Cornish |
First Address | Oklahoma City, OK 73150-1001 |
Second Address | Oklahoma City, OK 73150-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2015 |
Last Update Date | 19/09/2016 |