Provider Demographics
NPI:1174208722
Name:DRAKE, AMBER D (LPN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:D
Last Name:DRAKE
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 1:2902 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-1040
Mailing Address - Country:US
Mailing Address - Phone:304-939-5649
Mailing Address - Fax:
Practice Address - Street 1:2902 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-1040
Practice Address - Country:US
Practice Address - Phone:304-939-5649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32035164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse