Provider Demographics
NPI:1164725941
Name:AMBERG, ALAN ANTHONY (CNP, APRN)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:ANTHONY
Last Name:AMBERG
Suffix:
Gender:M
Credentials:CNP, APRN
Other - Prefix:MR
Other - First Name:ALAN
Other - Middle Name:TONY
Other - Last Name:AMBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, PMHNP-BC, APRN
Mailing Address - Street 1:35 E WACKER DR STE 1764
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-2271
Mailing Address - Country:US
Mailing Address - Phone:312-229-0029
Mailing Address - Fax:844-905-1504
Practice Address - Street 1:35 E WACKER DR STE 1764
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-2271
Practice Address - Country:US
Practice Address - Phone:872-276-8881
Practice Address - Fax:833-974-0916
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.387237163WP0808X
IL277000055363LP0808X
IL209011029363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922767573OtherGROUP NPI