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NPI Code Detail

MEDICARE: JESSICA LAUREN MAMULA PMHNP-BC

MEDICARE: JESSICA LAUREN MAMULA PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPN.0999571-NPCO

General Provider Information

NPI Number : 1679043319
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LAUREN MAMULA PMHNP-BC
Provider Business Mailing Address
First Line : 4419 CENTENNIAL BLVD UNIT 506
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-3739
Country : US
Telephone Number : 719-900-2481
Fax Number : 719-900-2483
Provider Business Practice Location Address
First Line : 3060 N ACADEMY BLVD STE 300
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80917-5349
Country : US
Telephone Number : 719-900-2481
Fax Number : 719-900-2483
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2018
Last Update Date : 03/24/2024

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