Healthcare Provider Details

I. General information

NPI: 1770633174
Provider Name (Legal Business Name): AMY LOU BROUWER ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 GREENWOOD PLAZA BLVD SUITE 300
CENTENNIAL CO
80111-4905
US

IV. Provider business mailing address

2328 S YUKON CT
LAKEWOOD CO
80227-3236
US

V. Phone/Fax

Practice location:
  • Phone: 303-267-3596
  • Fax: 303-267-3172
Mailing address:
  • Phone: 303-718-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number63985
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: