Healthcare Provider Details

I. General information

NPI: 1033732763
Provider Name (Legal Business Name): AMBER NICOLE DORROUGH MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 MCGINNIS DR
JUNEAU AK
99801
US

IV. Provider business mailing address

3807 MCGINNIS DR
JUNEAU AK
99801-8816
US

V. Phone/Fax

Practice location:
  • Phone: 907-419-0650
  • Fax: 907-519-0555
Mailing address:
  • Phone: 907-419-0650
  • Fax: 907-519-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number168406
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61186589
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number212380
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR098179
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number212975
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61186594
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number176690
License Number StateMT
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0137441TELE
License Number StateVT
# 9
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number162977
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: