Provider Demographics
NPI:1093020752
Name:CORONA, JAMMIE DAWN (ACNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JAMMIE
Middle Name:DAWN
Last Name:CORONA
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROSE LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-1147
Mailing Address - Country:US
Mailing Address - Phone:256-200-1192
Mailing Address - Fax:
Practice Address - Street 1:2024 BLACK JACK LOOP
Practice Address - Street 2:UNIT A
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-7272
Practice Address - Country:US
Practice Address - Phone:256-200-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY28495.1059363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner