Provider Demographics
NPI:1144973454
Name:ROHRBERG, AMBER KRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:KRISTINE
Last Name:ROHRBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 HANNAN TRACE RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25520-9085
Mailing Address - Country:US
Mailing Address - Phone:304-812-7436
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant