Provider Demographics
NPI:1487068292
Name:CORNNIELIES, DAJOUIR
Entity type:Individual
Prefix:
First Name:DAJOUIR
Middle Name:
Last Name:CORNNIELIES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 ENGLISH OAK CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2531
Mailing Address - Country:US
Mailing Address - Phone:513-320-2347
Mailing Address - Fax:
Practice Address - Street 1:4471 ENGLISH OAK CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2531
Practice Address - Country:US
Practice Address - Phone:513-320-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program