Provider Demographics
NPI:1730485483
Name:BERUBE, AMBER LYNN (WHNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:BERUBE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CROSSRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5568
Mailing Address - Country:US
Mailing Address - Phone:207-577-0010
Mailing Address - Fax:
Practice Address - Street 1:31 CROSSRIDGE DR
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5568
Practice Address - Country:US
Practice Address - Phone:207-577-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP111002363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health