=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396139903
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER LEE MAUTNER APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2015
-----------------------------------------------------
Last Update Date | 06/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 E EMMA AVE STE 300
-----------------------------------------------------
City | SPRINGDALE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72764-4469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-751-7417
-----------------------------------------------------
Fax | 479-751-4898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 W WALNUT ST
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72756-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-986-1300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | A004364
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------