Basic Information
| Provider Information | |||||||||
| NPI: | 1922130871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRODNAX | ||||||||
| FirstName: | CORA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN-APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 PONTIAC ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802204827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033200675 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2100 BROADWAY | ||||||||
| Address2: | COLORADO COALITION FOR THE HOMELESS | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802052526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032964996 | ||||||||
| FaxNumber: | 3032964436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 37631 | OH | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 37631 | 01 | CO | COLORADO NURSING REGIST. | OTHER |