Healthcare Provider Details

I. General information

NPI: 1013356864
Provider Name (Legal Business Name): AMANDA LYNN DEANGELIS CLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 STONE CUTTER RD
BELLVUE CO
80512-6508
US

IV. Provider business mailing address

179 STONE CUTTER RD
BELLVUE CO
80512-6508
US

V. Phone/Fax

Practice location:
  • Phone: 970-231-3060
  • Fax:
Mailing address:
  • Phone: 970-231-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number20131349037
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: