Individual
MRS. ROXANNE KAY CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
555 MIDTOWNE ST NE, SUITE 110, GRAND RAPIDS, MI 49503-5729
(616) 588-8880
Mailing address
8849 TAMARISK CIRCLE, RICHLAND, MI 49083
(269) 501-3143
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601003078
MI
Other
Enumeration date
12/21/2012
Last updated
12/21/2012
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