Healthcare Provider Details

I. General information

NPI: 1922130871
Provider Name (Legal Business Name): CORA JEAN BRODNAX RN-APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BROADWAY COLORADO COALITION FOR THE HOMELESS
DENVER CO
80205-2526
US

IV. Provider business mailing address

933 PONTIAC ST
DENVER CO
80220-4827
US

V. Phone/Fax

Practice location:
  • Phone: 303-296-4996
  • Fax: 303-296-4436
Mailing address:
  • Phone: 303-320-0675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number37631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: