Individual
MRS. KASSANDRA SUE KORNBAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP,PMHNP-BC,FNP-BC
Contact information
Practice address
3768 BOARDMAN CANFIELD RD # 5, CANFIELD, OH 44406-8502
(330) 798-0491
Mailing address
PO BOX 1098, DALLAS, NC 28034-1098
(330) 798-0491
(330) 303-4948
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
14139
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0082856
—
OH
01
—
H206462
MEDICARE PTAN
OH
Enumeration date
12/18/2012
Last updated
01/31/2025
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