Healthcare Provider Details

I. General information

NPI: 1063806966
Provider Name (Legal Business Name): AMITA I. SREENIVAS DNP, MPH, CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W BASELINE RD
LAFAYETTE CO
80026-1719
US

IV. Provider business mailing address

308 W BASELINE RD
LAFAYETTE CO
80026-1719
US

V. Phone/Fax

Practice location:
  • Phone: 303-351-1029
  • Fax: 303-970-1006
Mailing address:
  • Phone: 303-351-1029
  • Fax: 303-970-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60518676
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberC-APN.0102224-C-CNM
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: