Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0027794 | OH |
NPI | 1033789664 |
---|---|
Provider Name | Sara Cornelius |
First Address | Wadsworth, OH 44281-2124 |
Second Address | Akron, OH 44308-1063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2021 |
Last Update Date | 27/06/2021 |