Healthcare Provider Details

I. General information

NPI: 1194591743
Provider Name (Legal Business Name): MRS. AMBER MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 POPLAR ST
DAYTON OH
45415-2928
US

IV. Provider business mailing address

41 POPLAR ST
DAYTON OH
45415-2928
US

V. Phone/Fax

Practice location:
  • Phone: 937-580-8572
  • Fax:
Mailing address:
  • Phone: 937-580-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: