Provider Demographics
NPI:1790359396
Name:HUGHES, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:KAY
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5215 W CLEARWATER AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1900
Mailing Address - Country:US
Mailing Address - Phone:509-378-4323
Mailing Address - Fax:509-547-2808
Practice Address - Street 1:5215 W CLEARWATER AVE STE 106
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1900
Practice Address - Country:US
Practice Address - Phone:509-378-4323
Practice Address - Fax:509-547-2808
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1790359396OtherNPI