Provider Demographics
NPI:1942228762
Name:LANNIGAN, AMY B (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:LANNIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1573
Mailing Address - Country:US
Mailing Address - Phone:303-661-9080
Mailing Address - Fax:
Practice Address - Street 1:6055 W 46TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-1811
Practice Address - Country:US
Practice Address - Phone:303-423-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44816207R00000X, 208000000X
CODR-44816207R00000X, 208000000X
NE23099207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine