Provider Demographics
NPI:1528299773
Name:DOTY, AMBER FAYE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:FAYE
Last Name:DOTY
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:PO BOX 1273
Mailing Address - Street 2:
Mailing Address - City:WRIGHT
Mailing Address - State:WY
Mailing Address - Zip Code:82732-1273
Mailing Address - Country:US
Mailing Address - Phone:307-751-9206
Mailing Address - Fax:
Practice Address - Street 1:323 WAGONWHEEL DR
Practice Address - Street 2:
Practice Address - City:WRIGHT
Practice Address - State:WY
Practice Address - Zip Code:82732-1273
Practice Address - Country:US
Practice Address - Phone:307-751-9206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19703376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide