Provider Demographics
NPI:1982650602
Name:WING, AMY A (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:WING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:A
Other - Last Name:BRADSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2315 E HARMONY RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8620
Mailing Address - Country:US
Mailing Address - Phone:970-493-6337
Mailing Address - Fax:970-493-3528
Practice Address - Street 1:2315 E HARMONY RD
Practice Address - Street 2:SUITE 170
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8620
Practice Address - Country:US
Practice Address - Phone:970-493-6337
Practice Address - Fax:970-493-3528
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO125345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22201751Medicaid
CO22201751Medicaid