Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | ||
N | 176B00000X | Midwife |
NPI | 1275878779 |
---|---|
Provider Name | Gina Marie Penka Corriveau |
First Address | Brighton, CO 80601-7462 |
Second Address | Brighton, CO 80601-7462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2012 |
Last Update Date | 05/02/2017 |