Provider Demographics
NPI:1609120427
Name:CLONTZ, AMBER JAMES (FNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JAMES
Last Name:CLONTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1028 LEE ANN DR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2903
Mailing Address - Country:US
Mailing Address - Phone:704-782-1892
Mailing Address - Fax:704-786-1890
Practice Address - Street 1:1028 LEE ANN DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2903
Practice Address - Country:US
Practice Address - Phone:704-782-1892
Practice Address - Fax:704-786-1890
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily