Provider Demographics
NPI:1538903133
Name:CORNETT, AIDEN RACHELLE
Entity type:Individual
Prefix:
First Name:AIDEN
Middle Name:RACHELLE
Last Name:CORNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 TROY RD LOT 35
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8851
Mailing Address - Country:US
Mailing Address - Phone:813-624-4385
Mailing Address - Fax:
Practice Address - Street 1:4100 TROY RD LOT 35
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8851
Practice Address - Country:US
Practice Address - Phone:813-624-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker