Individual
VICTORIA L CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2751 N PACKERLAND DR, #103, GREEN BAY, WI 54303-4855
(920) 496-9977
Mailing address
2751 N PACKERLAND DR, #103, GREEN BAY, WI 54303-4855
(920) 496-9977
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0588019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41688500
—
WI
Enumeration date
04/09/2008
Last updated
04/09/2008
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