=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649167131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER BAILON LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2025
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 622 DEL SOL DR
-----------------------------------------------------
City | ALAMOSA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81101-8548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-587-6800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 622 DEL SOL DR
-----------------------------------------------------
City | ALAMOSA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81101-8548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN0337345
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------