Provider Demographics
NPI:1831812098
Name:SMITH, AMBER (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15946 REDMOND WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4061
Mailing Address - Country:US
Mailing Address - Phone:810-355-6336
Mailing Address - Fax:
Practice Address - Street 1:15946 REDMOND WAY STE 101
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4061
Practice Address - Country:US
Practice Address - Phone:425-588-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ292971363LF0000X
WAAP61349472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily