Michael Pat Cornwall, NURSE PRACTITIONER

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F301165-1 Issued in NY

Practice address

4646 Nine Mile Point Rd
Fairport, NY 14450-1163

Phone

(585) 377-0350

NPI assigned

Dec 7, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427117381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 EAST AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146102525",
            "telephone_number": "585-442-4156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 NINE MILE POINT RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144501163",
            "telephone_number": "585-377-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNWALL",
        "first_name": "MICHAEL",
        "middle_name": "PAT",
        "name_prefix": "Mr.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F301165-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PROVIDER NUMBER",
            "identifier": "500006563",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krista Elizabeth Cooley, PT, DPT
• Scott David Coon, DC
• Steven I Cooper, LCSW
• Katherine Corbett
• Joanne Pauliny Cordaro, M.D.
• Jessica Cortina
• Mitchel Costa, D.D.S.
• Stephanie Elaine-Marie Costantino
• Jeanmarie Courtney, MS OTR/L
• Nicole Cox, MS,CCC/SLP

• Adult Health Nurse Practitioner in Fairport, NY
• Providers in Fairport, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.