Provider Demographics
NPI:1063390276
Name:CORNISH, LINDSEY MARIE (FNP-C, MSN, RN, PCCN)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:CORNISH
Suffix:
Gender:F
Credentials:FNP-C, MSN, RN, PCCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13163 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-3335
Mailing Address - Country:US
Mailing Address - Phone:619-952-8089
Mailing Address - Fax:
Practice Address - Street 1:13163 SHENANDOAH DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-3335
Practice Address - Country:US
Practice Address - Phone:619-952-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily