Provider Demographics
NPI:1275781536
Name:HAM, AMBER KAY (LMP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:KAY
Last Name:HAM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13023 NE HIGHWAY 99
Mailing Address - Street 2:STE: 7
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2767
Mailing Address - Country:US
Mailing Address - Phone:360-608-9766
Mailing Address - Fax:360-834-6847
Practice Address - Street 1:532 NE 3RD AVE
Practice Address - Street 2:STE: 100
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2101
Practice Address - Country:US
Practice Address - Phone:360-834-6964
Practice Address - Fax:360-834-6847
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60036644172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker