Provider Demographics
NPI:1295007268
Name:WOLTER, AMBER K (PAC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:K
Last Name:WOLTER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ARMOUR
Mailing Address - State:SD
Mailing Address - Zip Code:57313-2102
Mailing Address - Country:US
Mailing Address - Phone:605-724-2151
Mailing Address - Fax:605-724-2310
Practice Address - Street 1:708 8TH ST
Practice Address - Street 2:
Practice Address - City:ARMOUR
Practice Address - State:SD
Practice Address - Zip Code:57313-2102
Practice Address - Country:US
Practice Address - Phone:605-724-2151
Practice Address - Fax:605-724-2310
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0808363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical