Provider Demographics
NPI:1710757521
Name:MOHELSKI, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MOHELSKI
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 1:2190 WALTER BRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-0340
Mailing Address - Country:US
Mailing Address - Phone:218-590-0564
Mailing Address - Fax:
Practice Address - Street 1:3112 TRAMWAY RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-7142
Practice Address - Country:US
Practice Address - Phone:919-775-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-14466363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant