Provider Demographics
NPI:1336185388
Name:GINN, AMY E (CNM MSN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:GINN
Suffix:
Gender:F
Credentials:CNM MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCADO ST # 145
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7300
Mailing Address - Country:US
Mailing Address - Phone:970-247-5543
Mailing Address - Fax:970-247-5545
Practice Address - Street 1:1 MERCADO ST # 145
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-247-5543
Practice Address - Fax:970-247-5545
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78415367A00000X
NM388367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM006476OtherBCBS
CO07784150Medicaid
L0458OtherNMCAID
COCO40984Medicare PIN
NMNM006476OtherBCBS
NML2588Medicare PIN