Provider Demographics
NPI:1902694011
Name:MERIWETHER, AMBER LATRICE
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LATRICE
Last Name:MERIWETHER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7639
Mailing Address - Country:US
Mailing Address - Phone:260-245-6374
Mailing Address - Fax:
Practice Address - Street 1:6030 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7639
Practice Address - Country:US
Practice Address - Phone:260-245-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker