Provider Demographics
NPI:1679001697
Name:RODRIGUEZ, AMANDA VICTORIA (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:VICTORIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3171
Mailing Address - Country:US
Mailing Address - Phone:303-717-3454
Mailing Address - Fax:
Practice Address - Street 1:9409 NEWTON ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3171
Practice Address - Country:US
Practice Address - Phone:303-717-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO166701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse