MEDICARE: ABRA CORINNE HOUCHIN CPM, RM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175M00000X	Lay Midwife	MWR.0000140	CO

General Provider Information

NPI Number	:	1366795668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABRA CORINNE HOUCHIN CPM, RM

Provider Business Mailing Address
First Line	:	520 N SHERWOOD ST UNIT 5
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2099
Country	:	US
Telephone Number	:	970-214-2508
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 N SHERWOOD ST UNIT 5
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2099
Country	:	US
Telephone Number	:	970-214-2508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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