Provider Demographics
NPI:1184649071
Name:COUSINEAU, CHRISTINE (GNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:COUSINEAU
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60545
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80960-0545
Mailing Address - Country:US
Mailing Address - Phone:719-481-2825
Mailing Address - Fax:719-481-2825
Practice Address - Street 1:1415 W CHEYENNE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-6211
Practice Address - Country:US
Practice Address - Phone:719-481-2825
Practice Address - Fax:719-481-2825
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO76935363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07769359Medicaid
COS31348Medicare UPIN
COCM3728Medicare PIN