Provider Demographics
NPI:1447705058
Name:WALDEN, AMBER (NP-C)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6326 STODDARD HAYES RD
Mailing Address - Street 2:
Mailing Address - City:FARMDALE
Mailing Address - State:OH
Mailing Address - Zip Code:44417-9707
Mailing Address - Country:US
Mailing Address - Phone:330-506-8336
Mailing Address - Fax:
Practice Address - Street 1:726 WICK AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2827
Practice Address - Country:US
Practice Address - Phone:330-747-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019447363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health