Provider Demographics
NPI:1750341947
Name:DEWEY, AMBER L (NP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:DEWEY
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 1:480 MAPLE ST
Mailing Address - Street 2:PAIN MANAGEMENT CENTER
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4065
Mailing Address - Country:US
Mailing Address - Phone:978-304-8600
Mailing Address - Fax:978-304-8621
Practice Address - Street 1:480 MAPLE ST
Practice Address - Street 2:PAIN MANAGEMENT CENTER
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-4065
Practice Address - Country:US
Practice Address - Phone:978-304-8600
Practice Address - Fax:978-304-8621
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252120363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1855221Medicaid
MA1855221Medicaid
MANP4897Medicare ID - Type Unspecified