Provider Demographics
NPI:1952070195
Name:VETTER, AMBER ELISA
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ELISA
Last Name:VETTER
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 1:10980 BILLINGS LN
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39325-9584
Mailing Address - Country:US
Mailing Address - Phone:575-520-0853
Mailing Address - Fax:
Practice Address - Street 1:10980 BILLINGS LN
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39325-9584
Practice Address - Country:US
Practice Address - Phone:575-520-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM912272163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient