Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APN.0993251 | CO |
NPI | 1073039376 |
---|---|
Provider Name | Ambria Repass |
First Address | Broomfield, CO 80023-6555 |
Second Address | San Antonio, TX 78205-2745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2017 |
Last Update Date | 17/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APN.0993251 | APN (01) | CO |