Provider Demographics
NPI:1184466849
Name:HIGGINBOTHAM, AMBER NICOLE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:HIGGINBOTHAM
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 1:10500 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:NEW VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45159-9005
Mailing Address - Country:US
Mailing Address - Phone:440-212-5804
Mailing Address - Fax:
Practice Address - Street 1:10500 CAREY RD
Practice Address - Street 2:
Practice Address - City:NEW VIENNA
Practice Address - State:OH
Practice Address - Zip Code:45159-9005
Practice Address - Country:US
Practice Address - Phone:440-212-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker