Provider Demographics
NPI:1588058531
Name:CORNIST, GLENDORA LYNNETTE (LPN)
Entity type:Individual
Prefix:
First Name:GLENDORA
Middle Name:LYNNETTE
Last Name:CORNIST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 NOHUNTA CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2569
Mailing Address - Country:US
Mailing Address - Phone:513-821-5105
Mailing Address - Fax:
Practice Address - Street 1:1028 NOHUNTA CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-2569
Practice Address - Country:US
Practice Address - Phone:513-821-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117691164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse