Provider Demographics
NPI:1013570803
Name:DENABURG, AMBER LYNNE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNNE
Last Name:DENABURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNNE
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:261 COUNTY ROAD 1403
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0596
Mailing Address - Country:US
Mailing Address - Phone:256-338-7504
Mailing Address - Fax:
Practice Address - Street 1:261 COUNTY ROAD 1403
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0596
Practice Address - Country:US
Practice Address - Phone:256-338-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125706367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered