Provider Demographics
NPI:1629745450
Name:PELDO, AMBER ELAINE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ELAINE
Last Name:PELDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19800 NE 259TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6908
Mailing Address - Country:US
Mailing Address - Phone:360-921-5708
Mailing Address - Fax:
Practice Address - Street 1:19800 NE 259TH ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-6908
Practice Address - Country:US
Practice Address - Phone:360-921-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician