Provider Demographics
NPI:1174072912
Name:BARBOUR, AMBER (LPN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BARBOUR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:OH
Mailing Address - Zip Code:45303-9721
Mailing Address - Country:US
Mailing Address - Phone:937-467-0568
Mailing Address - Fax:
Practice Address - Street 1:4124 BROWN RD
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:OH
Practice Address - Zip Code:45303-9721
Practice Address - Country:US
Practice Address - Phone:937-467-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.162973.MEDS.-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLPN.162973.MEDS-IVMedicaid