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General NPI Number Information
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NPI Number | 1679043319
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Entity Type | Individual
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Provider Name | JESSICA LAUREN MAMULA PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 03/24/2024
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Provider Practice Location Address
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Address Line | 3060 N ACADEMY BLVD STE 300
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-5349
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Country | US
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Telephone | 719-900-2481
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Fax | 719-900-2483
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Provider Business Mailing Address
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Address Line | 4419 CENTENNIAL BLVD UNIT 506
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-3739
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Country | US
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Telephone | 719-900-2481
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Fax | 719-900-2483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0999571-NP
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License Number State | CO
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