Individual
SAMANTHA CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 WAGNER ST, NEW ORLEANS, LA 70114-6131
(504) 578-2097
Mailing address
1701 WAGNER ST, NEW ORLEANS, LA 70114-6131
(504) 578-2097
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
08/09/2012
Last updated
08/09/2012
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