Healthcare Provider Details

I. General information

NPI: 1326618042
Provider Name (Legal Business Name): AMBER LINEBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 N FRANKLIN ST # 200
DENVER CO
80205-5437
US

IV. Provider business mailing address

PO BOX 462
PINE CO
80470-0462
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone: 303-260-9518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number0169619
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: