Healthcare Provider Details

I. General information

NPI: 1689241531
Provider Name (Legal Business Name): AMBERLEE MORE CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4679 SKYWRITER CIR
COLORADO SPRINGS CO
80922-2151
US

IV. Provider business mailing address

4679 SKYWRITER CIR
COLORADO SPRINGS CO
80922-2151
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA.0002692
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: