Provider Demographics
NPI:1114533635
Name:BALENTINE, AMBER MARIE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:BALENTINE
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:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:WV
Mailing Address - Zip Code:25081-0216
Mailing Address - Country:US
Mailing Address - Phone:304-896-4102
Mailing Address - Fax:
Practice Address - Street 1:6208 DANIEL BOONE PKWY
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:WV
Practice Address - Zip Code:25081
Practice Address - Country:US
Practice Address - Phone:304-896-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant