Healthcare Provider Details

I. General information

NPI: 1336707868
Provider Name (Legal Business Name): AMY M DVORAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 W 44TH AVE UNIT 200
WHEAT RIDGE CO
80033-2742
US

IV. Provider business mailing address

10900 W 44TH AVE UNIT 200
WHEAT RIDGE CO
80033-2742
US

V. Phone/Fax

Practice location:
  • Phone: 303-993-1330
  • Fax: 303-647-3647
Mailing address:
  • Phone: 720-923-1239
  • Fax: 303-284-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0197695
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRXN.0103822-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0994359-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: