Provider Demographics
NPI:1083330252
Name:WHITEFORD, AMBER L
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:WHITEFORD
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 1:9097 TALLMADGE RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:OH
Mailing Address - Zip Code:44412-9704
Mailing Address - Country:US
Mailing Address - Phone:330-419-0661
Mailing Address - Fax:
Practice Address - Street 1:9097 TALLMADGE RD
Practice Address - Street 2:
Practice Address - City:DIAMOND
Practice Address - State:OH
Practice Address - Zip Code:44412-9704
Practice Address - Country:US
Practice Address - Phone:330-419-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347C00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle