Healthcare Provider Details

I. General information

NPI: 1275780421
Provider Name (Legal Business Name): AMANDA N. LAWRY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 W 16TH ST STE B
GREELEY CO
80634-2910
US

IV. Provider business mailing address

5881 W 16TH ST STE B
GREELEY CO
80634-2910
US

V. Phone/Fax

Practice location:
  • Phone: 970-336-1500
  • Fax: 970-652-2937
Mailing address:
  • Phone: 970-336-1500
  • Fax: 970-652-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPRN-1587
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAP60030061
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN.0996913-CNM
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: