MEDICARE: AMY LEA BOREN REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	RN.0122110	CO

General Provider Information

NPI Number	:	1225858582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LEA BOREN REGISTERED NURSE

Provider Business Mailing Address
First Line	:	939 N 18TH ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2947
Country	:	US
Telephone Number	:	719-482-4644
Fax Number	:

Provider Business Practice Location Address
First Line	:	939 N 18TH ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2947
Country	:	US
Telephone Number	:	719-304-9966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2024
Last Update Date	:	10/11/2024

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