Provider Demographics
NPI:1306680764
Name:MAHRT, AMBER NICOLE (DNPC, MSN, RN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:MAHRT
Suffix:
Gender:F
Credentials:DNPC, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 N GRANT RD FRNT 141
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2569
Mailing Address - Country:US
Mailing Address - Phone:712-792-1755
Mailing Address - Fax:
Practice Address - Street 1:1328 2ND AVE N
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-1461
Practice Address - Country:US
Practice Address - Phone:712-269-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097364163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice