Provider Demographics
NPI:1063206191
Name:MOLE, AMBER CARLISSE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:CARLISSE
Last Name:MOLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4421
Mailing Address - Country:US
Mailing Address - Phone:267-422-2168
Mailing Address - Fax:
Practice Address - Street 1:502 W 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1333
Practice Address - Country:US
Practice Address - Phone:267-422-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA21683374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula