Healthcare Provider Details

I. General information

NPI: 1134548720
Provider Name (Legal Business Name): COURTNEY KORBAN CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 FRANCIS ST
LONGMONT CO
80501-5305
US

IV. Provider business mailing address

229 FRANCIS ST
LONGMONT CO
80501-5305
US

V. Phone/Fax

Practice location:
  • Phone: 720-579-2248
  • Fax:
Mailing address:
  • Phone: 720-579-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number0000141
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: