Provider Demographics
NPI:1538318662
Name:HERRICK, AMBER L (PA-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:HERRICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:L
Other - Last Name:BUHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:720-282-8010
Mailing Address - Fax:720-750-0390
Practice Address - Street 1:1550 S POTOMAC STREET
Practice Address - Street 2:#225
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5449
Practice Address - Country:US
Practice Address - Phone:720-282-8010
Practice Address - Fax:720-750-0390
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45375763Medicaid
CO344152YL7XMedicare PIN
COP01314839Medicare PIN