Provider Demographics
NPI:1225532393
Name:VANCE, AMBER STAR (LPN)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:STAR
Last Name:VANCE
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 1:124 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-8005
Mailing Address - Country:US
Mailing Address - Phone:330-749-9455
Mailing Address - Fax:
Practice Address - Street 1:124 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-8005
Practice Address - Country:US
Practice Address - Phone:330-749-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.158184.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse