Healthcare Provider Details

I. General information

NPI: 1962837567
Provider Name (Legal Business Name): ANDREA SUZANNE CORMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 E HARVARD AVE STE 400
DENVER CO
80231-5943
US

IV. Provider business mailing address

4020 STONEY CREEK DR
FORT COLLINS CO
80525-5621
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1400
  • Fax:
Mailing address:
  • Phone: 970-581-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0189591
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: