Healthcare Provider Details

I. General information

NPI: 1134443740
Provider Name (Legal Business Name): MELANIE AMBERGER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE C132
MOBILE AL
36608-3784
US

IV. Provider business mailing address

5671 RIVERVIEW PLANTATION DR
THEODORE AL
36582-5226
US

V. Phone/Fax

Practice location:
  • Phone: 251-631-3501
  • Fax:
Mailing address:
  • Phone: 251-443-5563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-073766
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: