Provider Demographics
NPI:1821302662
Name:YOUNGPETER, AMBER MICHELLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:MICHELLE
Last Name:YOUNGPETER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 SIERRA WAY
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-3687
Mailing Address - Country:US
Mailing Address - Phone:419-956-2170
Mailing Address - Fax:
Practice Address - Street 1:626 SIERRA WAY
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-3687
Practice Address - Country:US
Practice Address - Phone:419-956-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.136235-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse