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Individual
MRS. AMBER WALLACE LOPER
Active
Individual
MRS. AMBER WALLACE LOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9105182
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004025600
—
FL
01
—
12268338
CAQH
—
01
—
Y08MR
BLUE CROSS
—
Enumeration date
11/09/2009
Last updated
11/10/2016
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