Healthcare Provider Details

I. General information

NPI: 1528738861
Provider Name (Legal Business Name): AMBER HEIDELBERG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TERMINUS PL NE UNIT 1508
ATLANTA GA
30305-2586
US

IV. Provider business mailing address

20 TERMINUS PL NE UNIT 1508
ATLANTA GA
30305-2586
US

V. Phone/Fax

Practice location:
  • Phone: 501-817-6654
  • Fax:
Mailing address:
  • Phone: 501-817-6654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR106446
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: