Provider Demographics
NPI:1972575033
Name:RUFF, AMY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:RUFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:LOPOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST
Mailing Address - Street 2:21 MDOS/SGOC - PEDIATRICS
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-1277
Mailing Address - Fax:866-867-6792
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:21 MDOS/SGOC - PEDIATRICS
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-1277
Practice Address - Fax:866-867-7926
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN167858363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
92137OtherPEDIATRIC NURSING CERT BD