| NPI | 1992399067 |
|---|---|
| Former Name | COURTNEY LAUREN CORNELLA-CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 10762) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 10762-33) |
| 363L00000X Nurse Practitioner (Licence: WI 10762) | |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-03-22 |