Provider Demographics
NPI:1912355884
Name:LEED, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-1628
Mailing Address - Country:US
Mailing Address - Phone:717-426-1131
Mailing Address - Fax:717-426-2068
Practice Address - Street 1:1159 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:PA
Practice Address - Zip Code:17547-1628
Practice Address - Country:US
Practice Address - Phone:717-426-1131
Practice Address - Fax:717-426-2068
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily