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General NPI Number Information
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NPI Number | 1568310274
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Entity Type | Individual
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Provider Name | AMBER WILSON
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Gender | Female
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 1209 US ROUTE 66 W STE C
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City | MORIARTY
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State | NM
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Zip | 87035-1039
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Country | US
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Telephone | 505-226-1566
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Fax | 505-521-5191
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Provider Business Mailing Address
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Address Line | 15 WOODPECKER LN
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City | MORIARTY
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State | NM
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Zip | 87035-5392
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Country | US
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Telephone | 505-226-1460
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Fax | 505-521-5191
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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