Provider Demographics
NPI:1730687112
Name:CORDELL, CHRISTOPHER S (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:CORDELL
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B3
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3186
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:200 MEDICAL CENTER DR STE 375
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5180
Practice Address - Country:US
Practice Address - Phone:513-420-3773
Practice Address - Fax:513-420-3795
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022281363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology