Provider Demographics
NPI:1174110795
Name:BURTON, AMBER G
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:G
Last Name:BURTON
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 1:3126 MANNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26437-8712
Mailing Address - Country:US
Mailing Address - Phone:304-694-5546
Mailing Address - Fax:
Practice Address - Street 1:3126 MANNINGTON RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:WV
Practice Address - Zip Code:26437-8712
Practice Address - Country:US
Practice Address - Phone:304-694-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant