Provider Demographics
NPI:1255038709
Name:LEDBETTER, AMBER L (NP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 WAVERLY HILLS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4381
Mailing Address - Country:US
Mailing Address - Phone:517-231-1792
Mailing Address - Fax:
Practice Address - Street 1:1575 RAMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6384
Practice Address - Country:US
Practice Address - Phone:517-827-1800
Practice Address - Fax:517-827-1805
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704243810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily