| NPI | 1235456955 |
|---|---|
| Former Name | REBECCA TYSON CORNELISON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 266403) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2023-03-21 |