Healthcare Provider Details

I. General information

NPI: 1841803863
Provider Name (Legal Business Name): AMBER ENSCOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 WOODMAN DR STE 300
KETTERING OH
45420-1159
US

IV. Provider business mailing address

3085 WOODMAN DR STE 300
KETTERING OH
45420-1159
US

V. Phone/Fax

Practice location:
  • Phone: 937-963-5887
  • Fax: 937-963-5937
Mailing address:
  • Phone: 937-963-5887
  • Fax: 937-963-5937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: