Provider Demographics
NPI:1033985510
Name:CORNELL, SARAH NICOLE ROPER (FNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE ROPER
Last Name:CORNELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:NICOLE
Other - Last Name:CROWDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 WESLEY ELLISON RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-9580
Mailing Address - Country:US
Mailing Address - Phone:864-617-5532
Mailing Address - Fax:
Practice Address - Street 1:2 WESLEY ELLISON RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-9580
Practice Address - Country:US
Practice Address - Phone:864-617-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner