Provider Demographics
NPI:1134187305
Name:CORNWELL, JOYCE RUTH (ARNP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:RUTH
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:RUTH
Other - Last Name:SZCZEPANOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1600 DIAMOND ST
Practice Address - Street 2:
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-1548
Practice Address - Country:US
Practice Address - Phone:712-423-2231
Practice Address - Fax:712-423-3500
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21696-MULTI STATE163W00000X
IAA100852363L00000X
NE110134363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS94790Medicare UPIN