Individual
MRS. KATHLEEN ANNE CORNELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
9263 SOUTH LACJAC AVE, REEDLEY, CA 93654-9204
(559) 626-4819
Mailing address
9263 SOUTH LAC JAC AVE, REEDLEY, CA 93654-9204
(559) 638-5633
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
RN336307
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EPS015280
MEDICAL CHILDREN
CA
01
—
RVN003570
MEDICAL ADULT
CA
Enumeration date
04/11/2007
Last updated
07/08/2007
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