Provider Demographics
NPI:1609330356
Name:OKUBO, AMBER ROSE (CRNP-FAMILY)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ROSE
Last Name:OKUBO
Suffix:
Gender:F
Credentials:CRNP-FAMILY
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:ROSE
Other - Last Name:CANTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 FOREST RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-4678
Mailing Address - Country:US
Mailing Address - Phone:757-593-7423
Mailing Address - Fax:301-856-6623
Practice Address - Street 1:4475 REGENCY PL STE 201
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3074
Practice Address - Country:US
Practice Address - Phone:301-638-7802
Practice Address - Fax:301-638-7805
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR216474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily