Healthcare Provider Details

I. General information

NPI: 1144087024
Provider Name (Legal Business Name): AMANDA DEE SWOPE DNP AGACNP-BC FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

2245 EVERETT RD
PUEBLO CO
81006-1969
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4306
  • Fax:
Mailing address:
  • Phone: 719-248-6242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0999184-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999184-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: