Healthcare Provider Details

I. General information

NPI: 1265604516
Provider Name (Legal Business Name): AMIE C NELSON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 W ALAMEDA AVE
LAKEWOOD CO
80226-3007
US

IV. Provider business mailing address

9760 W 17TH AVE
LAKEWOOD CO
80215-2833
US

V. Phone/Fax

Practice location:
  • Phone: 303-239-7285
  • Fax:
Mailing address:
  • Phone: 303-550-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number112102
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: