Healthcare Provider Details

I. General information

NPI: 1467014142
Provider Name (Legal Business Name): AMBER MICHELLE PACKER RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CORPORATE PLAZA DR STE 150
NEWPORT BEACH CA
92660-7999
US

IV. Provider business mailing address

30 SHADE TREE
IRVINE CA
92603-0130
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-0708
  • Fax:
Mailing address:
  • Phone: 949-501-3905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number95036978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: