Provider Demographics
NPI:1073877486
Name:ALBA, AMANDA CHRISTINE (CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:ALBA
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CU COLLEGE OF NURSING
Mailing Address - Street 2:13120 E 19TH AVE, MAIL STOP F-711
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:720-848-1594
Mailing Address - Fax:720-848-1844
Practice Address - Street 1:1635 AURORA CT FL 3
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:720-848-1594
Practice Address - Fax:720-848-1844
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2300011367A00000X
COAPN.0996587-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400077591Medicare PIN
NY03484920Medicaid