Provider Demographics
NPI:1215735063
Name:CORNELIUS, KORI COLLEEN
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:COLLEEN
Last Name:CORNELIUS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 COVINGTON MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8368
Mailing Address - Country:US
Mailing Address - Phone:626-622-8676
Mailing Address - Fax:
Practice Address - Street 1:5471 COVINGTON MEADOWS DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8368
Practice Address - Country:US
Practice Address - Phone:626-622-8676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant