MEDICARE: AMY LOOMIS NP

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
1	363L00000X	Nurse Practitioner	APN.0992912-NP	CO
2	363LA2200X	Adult Health Nurse Practitioner	APN.0992912-NP	CO

General Provider Information

NPI Number	:	1851830913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LOOMIS NP

Provider Business Mailing Address
First Line	:	12900 PARK PLAZA DR STE 150
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-9329
Country	:	US
Telephone Number	:	562-677-2409
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 MARKET ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1607
Country	:	US
Telephone Number	:	303-534-5536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	11/25/2019

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