Healthcare Provider Details

I. General information

NPI: 1699903203
Provider Name (Legal Business Name): AMANDA C ROBICHAUD CFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4548 S BANNOCK ST
ENGLEWOOD CO
80110-5706
US

IV. Provider business mailing address

4548 S BANNOCK ST
ENGLEWOOD CO
80110-5706
US

V. Phone/Fax

Practice location:
  • Phone: 303-929-1090
  • Fax: 303-781-3627
Mailing address:
  • Phone: 303-929-1090
  • Fax: 303-781-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: