Provider Demographics
NPI:1487419065
Name:GINN, AMBER (IBCLC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GINN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 LONE HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-6242
Mailing Address - Country:US
Mailing Address - Phone:336-287-2042
Mailing Address - Fax:
Practice Address - Street 1:211 W WACKER DRIVE
Practice Address - Street 2:STE 120 #2053
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606
Practice Address - Country:US
Practice Address - Phone:336-287-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN