Individual
MR. ADAM R. CORNELIUSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3801 LAKE OTIS PKWY, SUITE 300, ANCHORAGE, AK 99508-5234
(907) 562-2277
(907) 563-3460
Mailing address
3801 LAKE OTIS PKWY, SUITE 300, ANCHORAGE, AK 99508-5234
(907) 562-2277
(907) 563-3460
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
104245
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1636106
—
AK
Enumeration date
09/16/2014
Last updated
01/21/2025
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