1194755835 NPI number — MS. CHERYL CORNELIUS MET

Table of content: MS. CHERYL CORNELIUS MET (NPI 1194755835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194755835 NPI number — MS. CHERYL CORNELIUS MET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORNELIUS
Provider First Name:
CHERYL
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MET
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194755835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 33310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89133-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-256-6090
Provider Business Mailing Address Fax Number:
702-256-1310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7375 PRAIRIE FALCON
Provider Second Line Business Practice Location Address:
160
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-256-6090
Provider Business Practice Location Address Fax Number:
702-256-6090
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LADC00684 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: MFT0433 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A963073 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".




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