Provider Demographics
NPI:1275864175
Name:ALLEN, AMBER LEIGH
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEIGH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5486 KILLEN AVE
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-5448
Mailing Address - Country:US
Mailing Address - Phone:303-638-4813
Mailing Address - Fax:
Practice Address - Street 1:5486 KILLEN AVE
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-5448
Practice Address - Country:US
Practice Address - Phone:303-638-4813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002078991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse