Cornwell, Shannon L
Cornwell, Shannon L is an sole proprietor health care provider with primary practice located at 101 E Valencia Mesa Dr Em Dept, Fullerton CA 92835-3809. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Cornwell, Shannon L can be contacted via phone (714) 992-3965.Contact Information
Primary practice address
101 E Valencia Mesa Dr Em Dept
Fullerton CA 92835-3809
Phone: (714) 992-3965
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA17022 | California |
Profile Details
| NPI number | 1902961626 |
|---|---|
| LBN Legal business name | Cornwell, Shannon L |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 22nd, 2006 |
| Last updated | Mar 11th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902961626 | NPPES |
| California | MEDICAID | WPA17022A | |
| California | Other | 330311953 |
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