Provider Demographics
NPI:1578872909
Name:CLOSE, AMBER LEE (APRN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:CLOSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-3020
Mailing Address - Country:US
Mailing Address - Phone:406-535-6545
Mailing Address - Fax:406-535-6549
Practice Address - Street 1:406 1ST AVE S
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-3020
Practice Address - Country:US
Practice Address - Phone:406-535-6545
Practice Address - Fax:406-535-6549
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily