Healthcare Provider Details

I. General information

NPI: 1932288446
Provider Name (Legal Business Name): CORINNE D HANISCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNE D CHURCH PA-C

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10555 E DARTMOUTH AVE SUITE 200
AURORA CO
80014-2645
US

IV. Provider business mailing address

10555 E DARTMOUTH AVE SUITE 200
AURORA CO
80014-2645
US

V. Phone/Fax

Practice location:
  • Phone: 303-991-4651
  • Fax: 303-991-3300
Mailing address:
  • Phone: 303-991-4651
  • Fax: 303-991-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2031
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: