Healthcare Provider Details

I. General information

NPI: 1699207548
Provider Name (Legal Business Name): AMY WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4985 BEACH CT
DENVER CO
80221-1207
US

IV. Provider business mailing address

4985 BEACH CT
DENVER CO
80221-1207
US

V. Phone/Fax

Practice location:
  • Phone: 405-833-0169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0197763
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: