Healthcare Provider Details

I. General information

NPI: 1619813862
Provider Name (Legal Business Name): AMBER LOUDERBACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 GREEN WAY
MARION OH
43302-5816
US

IV. Provider business mailing address

1039 HAHN RD
MANSFIELD OH
44906-1671
US

V. Phone/Fax

Practice location:
  • Phone: 740-725-4922
  • Fax:
Mailing address:
  • Phone: 740-725-4922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberSH936453
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: