MEDICARE: AMBER MARIE PROHASKA FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2014005154	MO

General Provider Information

NPI Number	:	1639594880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MARIE PROHASKA FNP-C

Provider Business Mailing Address
First Line	:	206 NW MOCK AVE
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2507
Country	:	US
Telephone Number	:	816-229-3265
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 NW MOCK AVE
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2507
Country	:	US
Telephone Number	:	816-229-3265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	02/25/2014

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