Provider Demographics
NPI:1265032460
Name:WEBB, AMBER RICHEAL
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RICHEAL
Last Name:WEBB
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 1:260 LOWER RIGHT FORK RD
Mailing Address - Street 2:
Mailing Address - City:FORT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25514-8087
Mailing Address - Country:US
Mailing Address - Phone:304-648-7422
Mailing Address - Fax:
Practice Address - Street 1:260 LOWER RIGHT FORK RD
Practice Address - Street 2:
Practice Address - City:FORT GAY
Practice Address - State:WV
Practice Address - Zip Code:25514-8087
Practice Address - Country:US
Practice Address - Phone:304-648-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant