Provider Demographics
NPI:1790233641
Name:FARRELL, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FARRELL
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 1:614 ENTRADA DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6908
Mailing Address - Country:US
Mailing Address - Phone:507-250-3323
Mailing Address - Fax:
Practice Address - Street 1:155 S MADISON ST
Practice Address - Street 2:#328
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3011
Practice Address - Country:US
Practice Address - Phone:303-393-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health