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General NPI Number Information
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NPI Number | 1639594880
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Entity Type | Individual
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Provider Name | AMBER MARIE PROHASKA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 206 NW MOCK AVE
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2507
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Country | US
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Telephone | 816-229-3265
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Fax |
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Provider Business Mailing Address
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Address Line | 206 NW MOCK AVE
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2507
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Country | US
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Telephone | 816-229-3265
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2014005154
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License Number State | MO
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