Provider Demographics
NPI:1578871588
Name:MATRONI, AMIE MARIE
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:MARIE
Last Name:MATRONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 ASHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-6317
Mailing Address - Country:US
Mailing Address - Phone:518-332-2431
Mailing Address - Fax:
Practice Address - Street 1:1400 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4014
Practice Address - Country:US
Practice Address - Phone:303-755-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21499183500000X
NC20507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920026Medicaid