Healthcare Provider Details

I. General information

NPI: 1306751565
Provider Name (Legal Business Name): AMBER PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 HILL RD
MANISTEE MI
49660-9201
US

IV. Provider business mailing address

2048 HILL RD
MANISTEE MI
49660-9201
US

V. Phone/Fax

Practice location:
  • Phone: 231-299-9444
  • Fax:
Mailing address:
  • Phone: 231-299-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: