Provider Demographics
NPI:1922332436
Name:FOREMAN, AMY MELISSA (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MELISSA
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 VOYAGER PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3747
Mailing Address - Country:US
Mailing Address - Phone:855-893-1032
Mailing Address - Fax:855-529-7670
Practice Address - Street 1:12710 VOYAGER PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3747
Practice Address - Country:US
Practice Address - Phone:855-893-1032
Practice Address - Fax:855-529-7670
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO173982163W00000X
CO10130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse