Provider Demographics
NPI:1881205300
Name:RODRIGUEZ, AMBER MASCHELL
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MASCHELL
Last Name:RODRIGUEZ
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 1:2103 42ND ST
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-6056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2103 42ND ST
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-6056
Practice Address - Country:US
Practice Address - Phone:505-486-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310940164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse