Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP11392 | AZ |
NPI | 1619460532 |
---|---|
Provider Name | Dr. Amber Marie Bahm |
First Address | Prescott, AZ 86305-3700 |
Second Address | Cottonwood, AZ 86326-3610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2018 |
Last Update Date | 14/06/2018 |