Provider Demographics
NPI:1881688489
Name:VALESH-PETERSON, AMY EILEEN (MSN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:EILEEN
Last Name:VALESH-PETERSON
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 ARAPAHOE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8054
Mailing Address - Country:US
Mailing Address - Phone:303-460-6020
Mailing Address - Fax:303-460-6021
Practice Address - Street 1:2970 ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8054
Practice Address - Country:US
Practice Address - Phone:303-460-6020
Practice Address - Fax:303-460-6021
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA104321363LC1500X
IAA-104321363LF0000X
COAPN.0994110-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2430835Medicaid
Q11363Medicare UPIN