Provider Demographics
NPI:1194394908
Name:WILSON, AMANDA MACKENZIE (MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MACKENZIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MACKENZIE
Other - Last Name:MCGLONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 WHEELING ST # A-211M
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 WHEELING ST
Practice Address - Street 2:MAIL CODE A-2-11M
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7211
Practice Address - Country:US
Practice Address - Phone:720-723-4859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO202001453163WC0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine