Healthcare Provider Details

I. General information

NPI: 1629309059
Provider Name (Legal Business Name): AMBER ROBERTSON NEAL CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 S MAIN ST STE D
BLACKSBURG VA
24060-7007
US

IV. Provider business mailing address

PO BOX 8310
ROANOKE VA
24014-0310
US

V. Phone/Fax

Practice location:
  • Phone: 540-605-7566
  • Fax:
Mailing address:
  • Phone: 540-345-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024176279
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR872356
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: