Provider Demographics
NPI:1528738861
Name:HEIDELBERG, AMBER (RN)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:
Last Name:HEIDELBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TERMINUS PL NE UNIT 1508
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2586
Mailing Address - Country:US
Mailing Address - Phone:501-817-6654
Mailing Address - Fax:
Practice Address - Street 1:20 TERMINUS PL NE UNIT 1508
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2586
Practice Address - Country:US
Practice Address - Phone:501-817-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR106446163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical