Individual
MR. MICHAEL PAT CORNWALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
4646 NINE MILE POINT RD, FAIRPORT, NY 14450-1163
(585) 377-0350
Mailing address
2416 EAST AVE, ROCHESTER, NY 14610-2525
(585) 442-4156
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F301165-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500006563
RAILROAD PROVIDER NUMBER
—
Enumeration date
12/07/2006
Last updated
07/08/2007
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