Provider Demographics
NPI:1366495921
Name:ROSS, AMBER M (CRNA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:M
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 24975
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0975
Mailing Address - Country:US
Mailing Address - Phone:425-353-2840
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-4260
Practice Address - Fax:206-598-8812
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00140090163W00000X
WAAP30007285367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9648429Medicaid
WA0208229OtherLABOR & INDUSTRY
WA82772UOtherREGENCE BLUESHIELD
WA8941290OtherL&I CRIME VICTIMS
WA8860236Medicare PIN