Basic Information
| Provider Information | |||||||||
| NPI: | 1619922671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMIREZ | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6162 S. WILLOW DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801115114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032209200 | ||||||||
| FaxNumber: | 3032209208 | ||||||||
| Practice Location | |||||||||
| Address1: | 13650 E MISSISSIPPI AVE | ||||||||
| Address2: | 100-B | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800123561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036951338 | ||||||||
| FaxNumber: | 3036958814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 09/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 109616 | CO | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 75685710 | 05 | CO | MEDICAID |