Individual
MRS. AMBER BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP-C
Contact information
Practice address
1914 W PARK DR, NORTH WILKESBORO, NC 28659-3563
(336) 903-7710
(336) 903-7711
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5005236
NC
363LF0000X
Family Nurse Practitioner
224111
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2335816
MEDICARE PTAN, GROUP
NC
01
—
NC2032A
MEDICARE PTAN, INDIVIDUAL
NC
Enumeration date
07/27/2011
Last updated
01/19/2024
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