Provider Demographics
NPI:1528398880
Name:WISNIEWSKI, AMBER LEIGH (RN, BSN, NP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEIGH
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:RN, BSN, NP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LEIGH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 S PARKER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1622
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-10
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO169808163W00000X
CO10115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO020780OtherKAISER COMMERCIAL NUMBER
CO92551572Medicaid
COCO307187Medicare PIN