Individual
ANDREA NICCOLE KORNELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 18TH AVE SE APT 55, MINOT, ND 58701-6613
(707) 450-7587
Mailing address
400 18TH AVE SE APT 55, MINOT, ND 58701-6613
(707) 450-7587
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-44631
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106S00000X
BEHAVIORAL HEALTH
CO
Enumeration date
05/07/2018
Last updated
05/21/2021
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