Individual
TYLER A CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
PSC 20090, CAMP LEJEUNE, NC 28542-0090
(760) 453-4511
Mailing address
120 WALNUT HILLS DR, RICHLANDS, NC 28574-8346
(760) 453-4511
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
1215693759
—
Other
Enumeration date
11/09/2021
Last updated
10/24/2023
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