Provider Demographics
NPI:1104378249
Name:ZUBKE, AMBER (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:
Last Name:ZUBKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 OCONOMOWOC AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-5214
Mailing Address - Country:US
Mailing Address - Phone:262-269-0152
Mailing Address - Fax:
Practice Address - Street 1:1405 OCONOMOWOC AVE APT 1
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-5214
Practice Address - Country:US
Practice Address - Phone:262-269-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319238164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse