Provider Demographics
NPI:1629686662
Name:COLBERT, AMBER MARIE (STNA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:COLBERT
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 VASHTI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-1830
Mailing Address - Country:US
Mailing Address - Phone:216-235-7212
Mailing Address - Fax:
Practice Address - Street 1:12425 VASHTI AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1830
Practice Address - Country:US
Practice Address - Phone:216-235-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care