Individual
EMILIZA CORNEJO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, APRN
Contact information
Practice address
133 ROUTE 3, DEDEDO, GU 96929-6911
(671) 645-5500
(671) 645-5549
Mailing address
PSC 78 BOX 1082, APO, AP 96326-0011
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
60375819
WA
163W00000X
Registered Nurse
766723
CA
163W00000X
Registered Nurse
RE2287
GU
363L00000X
Nurse Practitioner
Primary
NP0170
GU
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H110140
—
GU
Enumeration date
03/20/2017
Last updated
10/17/2017
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