Provider Demographics
NPI:1659844777
Name:EICHHORN, AMBER ZORN
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ZORN
Last Name:EICHHORN
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 1:2535 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4363
Mailing Address - Country:US
Mailing Address - Phone:985-447-0921
Mailing Address - Fax:985-447-0857
Practice Address - Street 1:2535 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4363
Practice Address - Country:US
Practice Address - Phone:985-447-0921
Practice Address - Fax:985-447-0857
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN141017163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse