Individual
AMETHYST ENTSUAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15403 PARK AVE E, VICTORVILLE, CA 92392-2482
(714) 633-6373
Mailing address
801 E KATELLA AVE, ANAHEIM, CA 92805-6614
(714) 633-6373
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95052687
CA
363L00000X
Nurse Practitioner
Primary
95024030
CA
Other
Enumeration date
01/20/2017
Last updated
03/29/2023
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