Provider Demographics
NPI:1194589176
Name:ANDERSON, AMBER DIANE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DIANE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 UPPER BOGGY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-7500
Mailing Address - Country:US
Mailing Address - Phone:207-717-7814
Mailing Address - Fax:
Practice Address - Street 1:417 STATE ST STE 421
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6639
Practice Address - Country:US
Practice Address - Phone:207-973-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP241033363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care