Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 191238 | CO |
NPI | 1003153719 |
---|---|
Provider Name | Amanda Nicole Coltrinari |
First Address | Grand Jct, CO 81502-1727 |
Second Address | Grand Junction, CO 81506-8701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2013 |
Last Update Date | 01/10/2021 |