Healthcare Provider Details

I. General information

NPI: 1619667078
Provider Name (Legal Business Name): AMBER MICHELLE ALBUS CNOR, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12634 OLIVE BLVD
SAINT LOUIS MO
63141-6337
US

IV. Provider business mailing address

1233 GUELBRETH LN APT 108
SAINT LOUIS MO
63146-5715
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-8000
  • Fax:
Mailing address:
  • Phone: 812-701-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number28178050C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: