Healthcare Provider Details

I. General information

NPI: 1609124445
Provider Name (Legal Business Name): AMBER ZUCHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 BRACKETT ST
PORTLAND ME
04102-3857
US

IV. Provider business mailing address

181 BRACKETT ST
PORTLAND ME
04102-3857
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-0105
  • Fax: 207-775-1392
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: