Healthcare Provider Details

I. General information

NPI: 1699611251
Provider Name (Legal Business Name): AMBER ROSE GALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W NAVITUS DR
APPLETON WI
54913-9017
US

IV. Provider business mailing address

877 W EVANS LN
SARATOGA SPRINGS UT
84045-2300
US

V. Phone/Fax

Practice location:
  • Phone: 920-221-4000
  • Fax:
Mailing address:
  • Phone: 801-472-7463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11279744-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: