Provider Demographics
NPI:1831716604
Name:VAN SICKLE-BIRCH, AMBER JANE (PMHNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JANE
Last Name:VAN SICKLE-BIRCH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PANCHERI DR STE 4
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3212
Mailing Address - Country:US
Mailing Address - Phone:208-579-6087
Mailing Address - Fax:888-519-8898
Practice Address - Street 1:1500 PANCHERI DR STE 4
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3212
Practice Address - Country:US
Practice Address - Phone:208-579-6087
Practice Address - Fax:888-519-8898
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID43554163WP0809X
ID70572363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult