Provider Demographics
NPI:1780111740
Name:KAMMERZELL, AMY DEAN (NP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DEAN
Last Name:KAMMERZELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WAGON WHEEL RD
Mailing Address - Street 2:
Mailing Address - City:HARTSEL
Mailing Address - State:CO
Mailing Address - Zip Code:80449-8563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4190 E WOODMEN RD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-632-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-21
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN.0102683-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology