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General NPI Number Information
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NPI Number | 1043490121
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Entity Type | Individual
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Provider Name | CORA NICOLE MATTIE PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 4045 PECOS ST STE 150
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City | DENVER
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State | CO
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Zip | 80211-2561
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Country | US
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Telephone | 720-730-7664
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Fax |
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Provider Business Mailing Address
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Address Line | 4045 PECOS ST STE 150
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City | DENVER
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State | CO
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Zip | 80211-2561
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Country | US
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Telephone | 720-730-7664
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Fax | 720-815-3104
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001867
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0003181
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License Number State | CO
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