Provider Demographics
NPI:1063269652
Name:GAHM, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GAHM
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 1:347 BACK ST
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-7710
Mailing Address - Country:US
Mailing Address - Phone:740-935-5819
Mailing Address - Fax:
Practice Address - Street 1:347 BACK ST
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-7710
Practice Address - Country:US
Practice Address - Phone:740-935-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide