Provider Demographics
NPI:1225591530
Name:STORM, AMELIA ELISABETH
Entity Type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:ELISABETH
Last Name:STORM
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 1:1041 CHERRY ST APT 6
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6096
Mailing Address - Country:US
Mailing Address - Phone:916-616-5593
Mailing Address - Fax:
Practice Address - Street 1:1276 HALYARD DR
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3412
Practice Address - Country:US
Practice Address - Phone:916-454-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date: