Provider Demographics
NPI:1073756797
Name:KREPP, AMBER M
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:KREPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61206 SMALL GRAFFI RD
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828
Mailing Address - Country:US
Mailing Address - Phone:541-663-7039
Mailing Address - Fax:
Practice Address - Street 1:61206 SMALL GRAFFI RD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-3039
Practice Address - Country:US
Practice Address - Phone:541-663-7039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNPC0003237372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion