Healthcare Provider Details

I. General information

NPI: 1437673878
Provider Name (Legal Business Name): AMY LYNN STOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MINERAL AVE
LITTLETON CO
80120-4547
US

IV. Provider business mailing address

801 W MINERAL AVE
LITTLETON CO
80120-4547
US

V. Phone/Fax

Practice location:
  • Phone: 303-815-5133
  • Fax: 303-942-4122
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1652818
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0107606
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0993635
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: