Healthcare Provider Details

I. General information

NPI: 1053520544
Provider Name (Legal Business Name): AMBER D DEVINE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER DIANE GRAF PA-C

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 SPRING VALLEY RD
BURLINGTON WI
53105-7614
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-971-9200
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2180
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2180-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: