Provider Demographics
NPI:1851724488
Name:ORELLANA, AMBER (FNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LEE
Other - Last Name:MATTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5981 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2211
Mailing Address - Country:US
Mailing Address - Phone:937-428-6702
Mailing Address - Fax:
Practice Address - Street 1:5981 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2211
Practice Address - Country:US
Practice Address - Phone:937-428-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5150363LF0000X
OH021249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ839290Medicaid
AZ839290Medicaid