Provider Demographics
NPI:1902577414
Name:PETCULESCU, AMBER (RN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PETCULESCU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44047 N 43RD AVE UNIT 74961
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-6050
Mailing Address - Country:US
Mailing Address - Phone:623-210-5758
Mailing Address - Fax:
Practice Address - Street 1:2701 W MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-4955
Practice Address - Country:US
Practice Address - Phone:623-445-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN174775163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool