| Doctor Name: | AMANDA BLACK |
| NPI Number: | 1609251073 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | APN.0991845-NP |
| Business Practice Address: | 327 Park Ave Fort Lupton, CO - 806211929 |
| Business Phone Number: | 3038572711 |
| Business Fax Number: | |
| Mailing Address: | 327 Park Ave, FORT LUPTON |
| State: | CO |
| Postal Code: | 806211929 |
| Phone Number: | 3038572711 |
| Fax Number: | |
| NPI Enumeration Date: | 07/27/2015 |
| NPI Last Update Date: | 07/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APN.0991845-NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |