Provider Demographics
NPI:1811395056
Name:LABANCZ, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LABANCZ
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 1:6922 KEATS AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9357
Mailing Address - Country:US
Mailing Address - Phone:651-399-5754
Mailing Address - Fax:
Practice Address - Street 1:6922 KEATS AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-9357
Practice Address - Country:US
Practice Address - Phone:651-399-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay