Provider Demographics
NPI:1447426812
Name:CORNETT, MARTIN W (CRNA)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:W
Last Name:CORNETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 AMBROSIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3888
Mailing Address - Country:US
Mailing Address - Phone:303-788-8888
Mailing Address - Fax:844-347-5158
Practice Address - Street 1:3911 AMBROSIA ST STE 201
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3888
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:844-347-5158
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0100041-CRNA367500000X
HIAPRN-1083367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH103755Medicare PIN