Provider Demographics
NPI:1619438819
Name:GENDRON, AMBER JUNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:JUNE
Last Name:GENDRON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:JUNE
Other - Last Name:SUITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 FERNCREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2563
Mailing Address - Country:US
Mailing Address - Phone:910-484-2171
Mailing Address - Fax:
Practice Address - Street 1:4140 FERNCREEK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2563
Practice Address - Country:US
Practice Address - Phone:910-484-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08912363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant