Provider Demographics
NPI:1376077016
Name:MALONE, AMY (LAC, RN, DIPLOM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LAC, RN, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 TENNYSON ST # 166
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2107
Mailing Address - Country:US
Mailing Address - Phone:585-747-5707
Mailing Address - Fax:
Practice Address - Street 1:405 URBAN ST STE 360
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1205
Practice Address - Country:US
Practice Address - Phone:720-593-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1621441163W00000X
COACU.0002290171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse