Provider Demographics
NPI:1043490121
Name:MATTIE, CORA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:NICOLE
Last Name:MATTIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4043
Mailing Address - Country:US
Mailing Address - Phone:303-632-3640
Mailing Address - Fax:303-632-3642
Practice Address - Street 1:14000 E ARAPAHOE RD
Practice Address - Street 2:SUITE 290
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4043
Practice Address - Country:US
Practice Address - Phone:303-632-3640
Practice Address - Fax:303-632-3642
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001867363A00000X
CO3181363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant