Healthcare Provider Details

I. General information

NPI: 1144466236
Provider Name (Legal Business Name): AMY MARION CARDONA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MARION WISCHMEYER NP

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTHPARK DR
LITTLETON CO
80120-5654
US

IV. Provider business mailing address

1000 SOUTHPARK DR
LITTLETON CO
80120-5654
US

V. Phone/Fax

Practice location:
  • Phone: 303-744-1065
  • Fax: 303-733-1699
Mailing address:
  • Phone: 303-744-1065
  • Fax: 303-733-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number128719
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: