Healthcare Provider Details

I. General information

NPI: 1740486836
Provider Name (Legal Business Name): AIMEE MARIE PANKAU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 E ARAPAHOE RD
GREENWOOD VILLAGE CO
80112-3703
US

IV. Provider business mailing address

9620 E ARAPAHOE RD
GREENWOOD VILLAGE CO
80112-3703
US

V. Phone/Fax

Practice location:
  • Phone: 303-835-9915
  • Fax: 303-320-5399
Mailing address:
  • Phone: 303-835-9915
  • Fax: 303-320-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number84384
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: