Provider Demographics
NPI:1881412336
Name:GERBER, AMBER (BA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GERBER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-0246
Mailing Address - Country:US
Mailing Address - Phone:208-234-2244
Mailing Address - Fax:
Practice Address - Street 1:403 N HAYES AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3025
Practice Address - Country:US
Practice Address - Phone:208-234-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator