Healthcare Provider Details

I. General information

NPI: 1689806440
Provider Name (Legal Business Name): AMBER MARIE STITZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 WOODWINDS DR
WOODBURY MN
55125-2270
US

IV. Provider business mailing address

6413 SUMMIT POINTE RD NW
ROCHESTER MN
55901-5657
US

V. Phone/Fax

Practice location:
  • Phone: 507-319-4858
  • Fax:
Mailing address:
  • Phone: 507-319-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberR 173899-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: