Provider Demographics
NPI:1932386190
Name:CORNILS, SHAREN K (RN, MFT)
Entity type:Individual
Prefix:MRS
First Name:SHAREN
Middle Name:K
Last Name:CORNILS
Suffix:
Gender:F
Credentials:RN, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-1658
Mailing Address - Country:US
Mailing Address - Phone:530-822-7215
Mailing Address - Fax:530-822-7223
Practice Address - Street 1:1445 VETERANS MEMORIAL CIR
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-3011
Practice Address - Country:US
Practice Address - Phone:530-822-7215
Practice Address - Fax:530-822-7223
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171922163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent