Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 708221 | TX |
NPI | 1003122532 |
---|---|
Provider Name | Ms. Amber Renee Hoberg |
First Address | San Antonio, TX 78257-5120 |
Second Address | San Antonio, TX 78229-4037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2010 |
Last Update Date | 24/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TXB157850 | WELLMED NETWORKS INC (01) | TX |