Provider Demographics
NPI:1689256190
Name:WACHTARZ, AMBER LAUREN (DNP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LAUREN
Last Name:WACHTARZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 GLASTONBURY PL UNIT 301
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4424
Mailing Address - Country:US
Mailing Address - Phone:860-202-2892
Mailing Address - Fax:
Practice Address - Street 1:711 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3060
Practice Address - Country:US
Practice Address - Phone:860-972-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9733363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology