1073141347 NPI number — AMBER NICOLE MACWILLIAM DO

Table of content: AMBER NICOLE MACWILLIAM DO (NPI 1073141347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073141347 NPI number — AMBER NICOLE MACWILLIAM DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACWILLIAM
Provider First Name:
AMBER
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACWILLIAM
Provider Other First Name:
AMBER
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073141347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-5700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-402-7256
Provider Business Mailing Address Fax Number:
888-902-1099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 CREEKSIDE XING STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130-7532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-302-4404
Provider Business Practice Location Address Fax Number:
830-302-4407
Provider Enumeration Date:
03/31/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  V2152 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)