# AMBER B MATTHYSSE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1558455311
- **Gender:** F
- **Credential:** MS PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 5601003436 | MI | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 02/18/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1047265 | PA CERTIFICATION | MI |
| 01 | — | 1153321047 | PECOS ID | — |
| 05 | — | 1558455311 | — | MI |
| 01 | — | 5601003436 | PA LICENSE | MI |
| 01 | — | MI11296005 | PTAN | MI |