Provider Demographics
NPI:1326728163
Name:STOMER, AMYAN ROSE
Entity Type:Individual
Prefix:
First Name:AMYAN
Middle Name:ROSE
Last Name:STOMER
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 1:3549 CURRY LN APT 2801
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2245
Mailing Address - Country:US
Mailing Address - Phone:361-658-1319
Mailing Address - Fax:
Practice Address - Street 1:3549 CURRY LN APT 2801
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2245
Practice Address - Country:US
Practice Address - Phone:361-658-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician