Healthcare Provider Details

I. General information

NPI: 1225415656
Provider Name (Legal Business Name): AMBER HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 VANBUREN ST. A409
JACKSON MI
49201-8915
US

IV. Provider business mailing address

308 VANBUREN ST. APT #A409
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-917-1312
  • Fax:
Mailing address:
  • Phone: 517-917-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703112236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: