Provider Demographics
NPI:1073603650
Name:CORNELIUS, ERIN M (PA-C)
Entity Type:Individual
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First Name:ERIN
Middle Name:M
Last Name:CORNELIUS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-716-8018
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:7950 KIPLING ST
Practice Address - Street 2:STE 101
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-3923
Practice Address - Country:US
Practice Address - Phone:303-425-4680
Practice Address - Fax:303-425-1616
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-02-16
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Provider Licenses
StateLicense IDTaxonomies
CO1704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72959541Medicaid
CO72959541Medicaid