MEDICARE: AMBER NICHOLE ROETHLISBERGER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	155333	IA

General Provider Information

NPI Number	:	1780201590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER NICHOLE ROETHLISBERGER RN

Provider Business Mailing Address
First Line	:	340 BOUNDARY AVE
Second Line	:
City	:	MIDDLETOWN
State	:	IA
Zip	:	52638-9716
Country	:	US
Telephone Number	:	319-981-5116
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 INDIAN HILLS DR
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-9406
Country	:	US
Telephone Number	:	319-752-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	06/26/2020

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