Provider Demographics
NPI:1770100059
Name:MCNULTY, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MCNULTY
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 1:300 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54213-9658
Mailing Address - Country:US
Mailing Address - Phone:920-495-2402
Mailing Address - Fax:
Practice Address - Street 1:600 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36082-2934
Practice Address - Country:US
Practice Address - Phone:800-414-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program