Provider Demographics
NPI:1497965602
Name:WRENN, AMY D (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:WRENN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13123 E 16TH AVE # B395
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-6181
Mailing Address - Fax:720-777-7283
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:B032
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6739
Practice Address - Fax:720-777-7347
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO176577363LF0000X, 363LP0200X, 363LP1700X
COAPN.0005015-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19970OtherKAISER COMMERCIAL NUMBER
CO89752571Medicaid
CO19970OtherKAISER COMMERCIAL NUMBER
COCOA104611Medicare PIN