Provider Demographics
NPI:1366018178
Name:REDD, AMBER LYN (CNM)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYN
Last Name:REDD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MADISON PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2057
Mailing Address - Country:US
Mailing Address - Phone:208-356-6185
Mailing Address - Fax:
Practice Address - Street 1:15 MADISON PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2057
Practice Address - Country:US
Practice Address - Phone:208-356-6185
Practice Address - Fax:208-356-0378
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID67865367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife