Provider Demographics
NPI:1508558420
Name:DAVIDSON, AMBER KATE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:KATE
Last Name:DAVIDSON
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 1:215 1ST AVE N APT 203
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3761
Mailing Address - Country:US
Mailing Address - Phone:701-215-1915
Mailing Address - Fax:
Practice Address - Street 1:215 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3760
Practice Address - Country:US
Practice Address - Phone:701-215-1915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant