Provider Demographics
NPI:1932288446
Name:HANISCH, CORINNE D (PA-C)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:D
Last Name:HANISCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:D
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10555 E DARTMOUTH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2645
Mailing Address - Country:US
Mailing Address - Phone:303-991-4651
Mailing Address - Fax:303-991-3300
Practice Address - Street 1:10555 E DARTMOUTH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2645
Practice Address - Country:US
Practice Address - Phone:303-991-4651
Practice Address - Fax:303-991-3300
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2031363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1064344OtherNCCPA CERTIFICATION
COQ37621Medicare UPIN