Provider Demographics
NPI:1184370900
Name:MACDONALD, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MACDONALD
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 1:51 BRENTON ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03052-1070
Mailing Address - Country:US
Mailing Address - Phone:603-313-0079
Mailing Address - Fax:
Practice Address - Street 1:51 BRENTON ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:NH
Practice Address - Zip Code:03052-1070
Practice Address - Country:US
Practice Address - Phone:603-313-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date: