MEDICARE: CHRISTOPHER CORAM NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	T-APN.0000022	CO
2	363LA2100X	Acute Care Nurse Practitioner	APRN-5407	HI
3	363LA2100X	Acute Care Nurse Practitioner	APN.0996057-NP	CO
4	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1134726391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER CORAM NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 7702
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-0702
Country	:	US
Telephone Number	:	970-663-2742
Fax Number	:	970-342-2093

Provider Business Practice Location Address
First Line	:	115 E RIVERWALK UNIT 200
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-3320
Country	:	US
Telephone Number	:	195-438-3467
Fax Number	:	719-545-1829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	12/15/2025

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Directions to “ CHRISTOPHER CORAM NURSE PRACTITIONER” Practice Location

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