Healthcare Provider Details

I. General information

NPI: 1689192189
Provider Name (Legal Business Name): MRS. AMBYR LINN PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBYR LINN MACHELSKI

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N MICHIGAN AVE
SAGINAW MI
48602-4732
US

IV. Provider business mailing address

221 W MIDLAND RD
AUBURN MI
48611-9411
US

V. Phone/Fax

Practice location:
  • Phone: 989-401-9033
  • Fax:
Mailing address:
  • Phone: 989-615-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: