Healthcare Provider Details

I. General information

NPI: 1144209545
Provider Name (Legal Business Name): AMANDA PITMAN LOVETTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA PITMAN SIJ MD

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 STAFFORD LN
DELTA CO
81416-2243
US

IV. Provider business mailing address

PO BOX 10100
DELTA CO
81416-0008
US

V. Phone/Fax

Practice location:
  • Phone: 970-546-4000
  • Fax:
Mailing address:
  • Phone: 970-546-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK2797
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: