Provider Demographics
NPI:1689192189
Name:PETERS, AMBYR LINN
Entity Type:Individual
Prefix:MRS
First Name:AMBYR
Middle Name:LINN
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBYR
Other - Middle Name:LINN
Other - Last Name:MACHELSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 W MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9411
Mailing Address - Country:US
Mailing Address - Phone:989-615-3979
Mailing Address - Fax:
Practice Address - Street 1:1300 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4732
Practice Address - Country:US
Practice Address - Phone:989-401-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other