AMANDA MULLEN (NPI# 1336636778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336636778 |
| Entity Type | Individual |
| Full Name | AMANDA MULLEN |
| Credential | MD |
| Practice Address |
902 Lakeview Ave Pueblo CO 81004 |
| Mailing Address |
902 Lakeview Ave Pueblo CO 81004-3597 |
| Practice Telephone | 7195575872 |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2018-07-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | TL.0007373 | CO | Allopathic & Osteopathic Physicians |
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | TL.0007373 | CO | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316329212 | Amanda Mullen | Speech-Language Pathologist | 180 Orange Rd, Apt 5b, Montclair, NJ 07042-2644 | 2015-06-26 |
| 1376509752 | Amanda Mullen | Psychologist | 25 Main St, Suite 208, Northampton, MA 01060-3109 | 2006-04-25 |
| Street Address |
902 LAKEVIEW AVE |
| City | PUEBLO |
| State | CO |
| Zip Code | 81004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376549840 | Laura A Stein | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004 | 2005-06-21 |
| 1972114676 | Catholic Health Initiatives Colorado | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-08-14 |
| 1275154668 | Alexander Thomas Grover | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-27 |
| 1336769843 | Sydney Marie Brock | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-24 |
| 1225658172 | Ashima Singh | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-21 |
| 1467072249 | Joel Scott Bonzo | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-21 |
| 1023638053 | Patrick Henke | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-20 |
| 1659991917 | Kelsi Rae Brown | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-16 |
| 1205474210 | John De Villa | Nurse Practitioner | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2019-12-20 |
| 1033773627 | Queenter Kisang | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2019-04-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780155929 | Renee C Lane | Nurse Practitioner | 1925 E. Orman Ave. Ste. A109, Pueblo, CO 81004 | 2018-12-16 |
| 1215406913 | Kaiser Foundation Healthplan of Colorado | Pharmacy | 2625 W. Pueblo Blvd, Pueblo, CO 81004 | 2018-11-26 |
| 1053895532 | Rebecka Ann Reatherford | Nurse Practitioner | St Mary-corwin Medical Center, 1008 Minnequa Ave, Pueblo, CO 81004 | 2018-09-20 |
| 1124510821 | Angela M Sillas-green | Counselor | 327 Colorado Ave., Pueblo, CO 81004 | 2018-05-30 |
| 1558898569 | Alexandra R B King | Family Medicine | Southern Colorado Family Medicine, 902 Lakeview Avenue, Pueblo, CO 81004 | 2017-05-22 |
| 1578098752 | James Williams | Counselor | 414 Broadway Ave, Pueblo, CO 81004 | 2017-04-26 |
| 1740732601 | Valerie A Senger | Counselor | 635 W Corona Ave Ste 214, Pueblo, CO 81004 | 2016-10-26 |
| 1194111500 | A New Leaf Therapy, Pllc | Community/Behavioral Health | 327 Colorado Ave, Pueblo, CO 81004 | 2015-04-13 |
| 1619371671 | Mariah Mcginnis | Registered Nurse | 1232 Van Buren St., Pueblo, CO 81004 | 2014-10-20 |
| 1730593112 | Maritza Martinez | Registered Nurse | 1026 Wabriendo Ave, Pueblo, CO 81004 | 2014-06-13 |
| Find all providers in zip 81004 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164042016 | Sunil Kumar | Student in an Organized Health Care Education/Training Program | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2020-04-21 |
| 1003276528 | Rachel Elizabeth Black | Student in an Organized Health Care Education/Training Program | 5306 Outlook Blvd Unit 101, Pueblo, CO 81008-1399 | 2016-02-25 |
| 1487041331 | Joshua Jay Borer | Student in an Organized Health Care Education/Training Program | 786 N Boyero Ave, Pueblo, CO 81007-1299 | 2015-04-17 |
| 1811598907 | Amira Bakkar | Student in an Organized Health Care Education/Training Program | 311 W 14th St, Pueblo, CO 81003-2705 | 2020-11-04 |
| 1497373682 | Manaquibb Zain Ali Shaheer Khan | Student in an Organized Health Care Education/Training Program | 311 W 14th St, Pueblo, CO 81003-2705 | 2020-07-14 |
| 1154949584 | Sohaib Ahmed Khan | Student in an Organized Health Care Education/Training Program | 311 W 14th St, Pueblo, CO 81003-2705 | 2020-07-13 |
| 1427678986 | Blayne Anne Knapp | Student in an Organized Health Care Education/Training Program | 311 W 14th St, Pueblo, CO 81003-2705 | 2020-04-24 |
| 1881214567 | Nathan S Grigg | Student in an Organized Health Care Education/Training Program | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-04-22 |
| 1053931980 | David Allen Mcmillan | Student in an Organized Health Care Education/Training Program | 311 W 14th St, Pueblo, CO 81003-2705 | 2020-04-21 |
| 1699395822 | Neil Ashok Patel | Student in an Organized Health Care Education/Training Program | 311 W 14th St, Pueblo, CO 81003-2705 | 2020-04-17 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.