Provider Demographics
NPI:1932796430
Name:STOLTZ, AMBER NICOLE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:STOLTZ
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 1:607 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1646
Mailing Address - Country:US
Mailing Address - Phone:419-852-3643
Mailing Address - Fax:
Practice Address - Street 1:607 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1646
Practice Address - Country:US
Practice Address - Phone:419-852-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
OHUG502884347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle