Provider Demographics
NPI:1942799960
Name:WILBURN, AMBER MAE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MAE
Last Name:WILBURN
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 1:14082 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-9402
Mailing Address - Country:US
Mailing Address - Phone:530-209-7820
Mailing Address - Fax:
Practice Address - Street 1:1445 VISTA WAY
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4510
Practice Address - Country:US
Practice Address - Phone:530-527-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide