Provider Demographics
NPI:1679139927
Name:SCHREITER, KORNELIA
Entity Type:Individual
Prefix:
First Name:KORNELIA
Middle Name:
Last Name:SCHREITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 S RICHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5221
Mailing Address - Country:US
Mailing Address - Phone:720-327-6308
Mailing Address - Fax:
Practice Address - Street 1:1679 S RICHFIELD ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5221
Practice Address - Country:US
Practice Address - Phone:720-327-6308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO824526762Medicaid
CO253E00000XMedicaid