Provider Demographics
NPI:1821282682
Name:RANTALA, CORINNE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:MARIE
Last Name:RANTALA
Suffix:
Gender:F
Credentials:PA
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 2153 DEPT 40339
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9387
Mailing Address - Country:US
Mailing Address - Phone:706-271-0100
Mailing Address - Fax:
Practice Address - Street 1:14221 E EVANS AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1459
Practice Address - Country:US
Practice Address - Phone:303-751-2000
Practice Address - Fax:303-225-4246
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33625336Medicaid
CO33625336Medicaid