Provider Demographics
NPI:1417283722
Name:OSSIAN, AMY LYNNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNNE
Last Name:OSSIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNNE
Other - Last Name:SONNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2100 16TH ST UNIT 212
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5184
Mailing Address - Country:US
Mailing Address - Phone:720-375-3811
Mailing Address - Fax:
Practice Address - Street 1:1001 S PERRY ST STE 101B
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1921
Practice Address - Country:US
Practice Address - Phone:303-699-1395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPAL 2845363A00000X
UT7752075-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-1489728OtherTAX ID