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AMANDA BLACK FNP-BC

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1609251073

Individual Registrant:
 AMANDA  BLACK FNP-BC
Gender: F
Not Sole Proprietor

Location and contact information for practice:
327 PARK AVE  FORT LUPTON, CO 80621-1929 US
Tel: 303-857-2711  Fax: --

Contact information for business:
327 PARK AVE  FORT LUPTON, CO 80621-1929 US
Tel: 303-857-2711  Fax: --

Registration Information:
NPI: 1609251073
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
COAPN.0991845-NP

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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