Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 01068286A | IN |
NPI | 1376607028 |
---|---|
Provider Name | Amberly L Burger |
First Address | South Bend, IN 46617-1924 |
Second Address | Mishawaka, IN 46544-4249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200983920 | (05) | IN |
P01472095 | RR MEDICARE (01) | IN |