Provider Demographics
NPI:1396139903
Name:MAUTNER, AMBER LEE (APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:MAUTNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3521
Mailing Address - Country:US
Mailing Address - Phone:479-986-1300
Mailing Address - Fax:
Practice Address - Street 1:614 E EMMA AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4469
Practice Address - Country:US
Practice Address - Phone:479-751-7417
Practice Address - Fax:479-751-4898
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004364363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health