Healthcare Provider Details

I. General information

NPI: 1306387139
Provider Name (Legal Business Name): AMBER DAY VA60469869
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 S LYLE AVE
E WENATCHEE WA
98802-9291
US

IV. Provider business mailing address

456 S LYLE AVE
E WENATCHEE WA
98802-9291
US

V. Phone/Fax

Practice location:
  • Phone: 951-235-2639
  • Fax:
Mailing address:
  • Phone: 951-235-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberVA60469869
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: