Healthcare Provider Details

I. General information

NPI: 1992941579
Provider Name (Legal Business Name): RHIA J CORSENTINO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RHIA J RETHLAKE R.N.

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD STE 315
COLORADO SPRINGS CO
80910-3126
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-3700
  • Fax:
Mailing address:
  • Phone: 970-624-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000149934
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0004731-C-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19113
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11008045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: