Individual
SHANNON CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
115 N SUMTER ST STE 410, SUMTER, SC 29150-4969
(803) 774-9797
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
22165
SC
363LA2200X
Adult Health Nurse Practitioner
APN.0991755-NP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP5392
—
SC
Enumeration date
05/07/2015
Last updated
10/29/2018
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