Healthcare Provider Details

I. General information

NPI: 1184649071
Provider Name (Legal Business Name): CHRISTINE COUSINEAU GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W CHEYENNE MOUNTAIN BLVD
COLORADO SPRINGS CO
80906-6211
US

IV. Provider business mailing address

PO BOX 60545
COLORADO SPRINGS CO
80960-0545
US

V. Phone/Fax

Practice location:
  • Phone: 719-481-2825
  • Fax: 719-481-2825
Mailing address:
  • Phone: 719-481-2825
  • Fax: 719-481-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number76935
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: