Provider Demographics
NPI:1497139323
Name:STAEDTLER, AMBER VICTORIA (DNP AGNP-BC)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:VICTORIA
Last Name:STAEDTLER
Suffix:
Gender:F
Credentials:DNP AGNP-BC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4141 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6021
Mailing Address - Country:US
Mailing Address - Phone:605-341-2424
Mailing Address - Fax:
Practice Address - Street 1:4141 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6021
Practice Address - Country:US
Practice Address - Phone:605-341-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000951363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health