Provider Demographics
NPI:1932779816
Name:CONNIFF, AMBER RAE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE
Last Name:CONNIFF
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 1:6867 COUNTY 20
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55921-2809
Mailing Address - Country:US
Mailing Address - Phone:507-458-2642
Mailing Address - Fax:
Practice Address - Street 1:6867 COUNTY 20
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MN
Practice Address - Zip Code:55921-2809
Practice Address - Country:US
Practice Address - Phone:507-458-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program