Basic Information
| Provider Information | |||||||||
| NPI: | 1194344853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | AMBER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 JOHN ST STE M-170 | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693815060 | ||||||||
| FaxNumber: | 2693811655 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 JOHN ST STE M-170 | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693815060 | ||||||||
| FaxNumber: | 2693811655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2020 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP2201X | 4704306265 | MI | Y | Nursing Service Providers | Registered Nurse | Ambulatory Care |
No ID Information.