Provider Demographics
NPI:1821309444
Name:DVORAK, AMBER NICHOLE (LMP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICHOLE
Last Name:DVORAK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N STANLEY ST
Mailing Address - Street 2:STE. C
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8939
Mailing Address - Country:US
Mailing Address - Phone:509-299-6900
Mailing Address - Fax:
Practice Address - Street 1:725 N STANLEY ST
Practice Address - Street 2:STE. C
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8939
Practice Address - Country:US
Practice Address - Phone:509-299-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist