Provider Demographics
NPI:1316925241
Name:MITCHELL- LEDESMA, AMBER JEAN
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JEAN
Last Name:MITCHELL- LEDESMA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:JEAN
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21615 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-7703
Mailing Address - Country:US
Mailing Address - Phone:253-431-7391
Mailing Address - Fax:
Practice Address - Street 1:21615 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-7703
Practice Address - Country:US
Practice Address - Phone:206-878-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00058119183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician