Individual
SUZANNE RENEE CORNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8501 HARCOURT RD, INDIANAPOLIS, IN 46260-2046
(317) 875-9105
(317) 808-8802
Mailing address
8501 HARCOURT RD, INDIANAPOLIS, IN 46260-2046
(317) 875-9105
(317) 875-8638
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000345959
ANTHEM HEALTH PLAN
—
05
—
300006437
—
IN
01
—
P00301231
RR MEDICARE
IN
Enumeration date
08/17/2006
Last updated
04/01/2024
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