Individual
PAMELA S CORNWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7411 HOPE DR, FORT WAYNE, IN 46815-5687
(260) 264-5600
(260) 444-2082
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28150677A
IN
363LF0000X
Family Nurse Practitioner
Primary
71010035A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100155290
—
IN
Enumeration date
02/19/2015
Last updated
04/04/2022
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