Provider Demographics
NPI:1215431556
Name:GROB, AMBER (APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GROB
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 W 103RD DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2453
Mailing Address - Country:US
Mailing Address - Phone:402-779-9195
Mailing Address - Fax:
Practice Address - Street 1:4891 INDEPENDENCE ST STE 225
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6849
Practice Address - Country:US
Practice Address - Phone:720-779-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2023-03-07
Deactivation Date:2020-12-29
Deactivation Code:
Reactivation Date:2021-01-22
Provider Licenses
StateLicense IDTaxonomies
NE1124252084P0804X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEMG4728385OtherDEA