Provider Demographics
NPI:1942651484
Name:CORNELIUS, BETH (LPN)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:CORNELIUS
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 1:11465 FLAGLER LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2615
Mailing Address - Country:US
Mailing Address - Phone:513-485-1575
Mailing Address - Fax:
Practice Address - Street 1:11465 FLAGLER LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2615
Practice Address - Country:US
Practice Address - Phone:513-485-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse