Individual
JESSICA LEE CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
629 21ST ST S APT 4, FARGO, ND 58103-2487
(701) 353-9257
Mailing address
2201 6TH AVE S, FARGO, ND 58103-2411
(701) 515-8117
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
10/13/2021
Last updated
10/13/2021
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