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General NPI Number Information
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NPI Number | 1790233641
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Entity Type | Individual
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Provider Name | AMANDA FARRELL
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Gender | Female
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 155 S MADISON ST #328
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City | DENVER
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State | CO
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Zip | 80209-3011
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Country | US
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Telephone | 303-393-1726
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Fax |
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Provider Business Mailing Address
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Address Line | 614 ENTRADA DR
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City | GOLDEN
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State | CO
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Zip | 80401-6908
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Country | US
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Telephone | 507-250-3323
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Fax |
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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 | 0992570
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License Number State | CO
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