Healthcare Provider Details

I. General information

NPI: 1447406285
Provider Name (Legal Business Name): AMBER NICOLE WOOTEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 TIETON DR STE 300
YAKIMA WA
98902
US

IV. Provider business mailing address

3800 SUMMITVIEW AVE
YAKIMA WA
98902-2715
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-3946
  • Fax: 509-225-2701
Mailing address:
  • Phone: 509-248-7849
  • Fax: 509-248-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number28393
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: