Provider Demographics
NPI:1841932613
Name:HUESKE, CORALEE ELIZABETH
Entity type:Individual
Prefix:
First Name:CORALEE
Middle Name:ELIZABETH
Last Name:HUESKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 MYRON CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-8957
Mailing Address - Country:US
Mailing Address - Phone:720-250-6269
Mailing Address - Fax:
Practice Address - Street 1:3055 47TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5469
Practice Address - Country:US
Practice Address - Phone:303-442-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002057981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice