Provider Demographics
NPI:1922130871
Name:BRODNAX, CORA JEAN (RN-APN)
Entity Type:Individual
Prefix:MS
First Name:CORA
Middle Name:JEAN
Last Name:BRODNAX
Suffix:
Gender:F
Credentials:RN-APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 PONTIAC ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4827
Mailing Address - Country:US
Mailing Address - Phone:303-320-0675
Mailing Address - Fax:
Practice Address - Street 1:2100 BROADWAY
Practice Address - Street 2:COLORADO COALITION FOR THE HOMELESS
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2526
Practice Address - Country:US
Practice Address - Phone:303-296-4996
Practice Address - Fax:303-296-4436
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH37631163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37631OtherCOLORADO NURSING REGIST.