Provider Demographics
NPI:1083331268
Name:DEITERING, AMBER MARIE (RN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:DEITERING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:SLAGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29813 111TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-2517
Mailing Address - Country:US
Mailing Address - Phone:253-350-3526
Mailing Address - Fax:
Practice Address - Street 1:9801 FRONTIER AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5200
Practice Address - Country:US
Practice Address - Phone:425-831-3428
Practice Address - Fax:425-831-2369
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60992220163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse