Provider Demographics
NPI:1942776471
Name:EASTWOOD, AMBER LANE
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LANE
Last Name:EASTWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LANE
Other - Last Name:BUSTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4025 APPLEYARD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1272
Mailing Address - Country:US
Mailing Address - Phone:972-948-5927
Mailing Address - Fax:
Practice Address - Street 1:10864 TEXAS HEALTH TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4897
Practice Address - Country:US
Practice Address - Phone:972-948-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant