Basic Information
Provider Information
NPI: 1003153719
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLTRINARI
FirstName: AMANDA
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BULLER
OtherFirstName: AMANDA
OtherMiddleName: NICOLE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: NP
OtherLastNameType: 1
Mailing Information
Address1: 743 HORIZON CT
Address2: SUITE 100
City: GRAND JUNCTION
State: CO
PostalCode: 815068701
CountryCode: US
TelephoneNumber: 9702417600
FaxNumber: 9702634831
Practice Location
Address1: 743 HORIZON CT
Address2: SUITE 100
City: GRAND JUNCTION
State: CO
PostalCode: 815068701
CountryCode: US
TelephoneNumber: 9702417600
FaxNumber: 9702634831
Other Information
ProviderEnumerationDate: 01/15/2013
LastUpdateDate: 04/10/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X191238COY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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