Provider Demographics
NPI:1316668114
Name:PERKINS, AMBER (RN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMBER SMITH RN
Mailing Address - Street 1:8841 MARION
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1733
Mailing Address - Country:US
Mailing Address - Phone:248-403-1255
Mailing Address - Fax:
Practice Address - Street 1:8841 MARION
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1733
Practice Address - Country:US
Practice Address - Phone:248-403-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704349525163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI85-1960176Medicaid