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Individual

AMBER BREWER KELLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4618 COUNTRY CLUB RD, WINSTON SALEM, NC 27104-3520
(336) 716-1763
Mailing address
MEDICAL CENTER BLVD, WFU SCHOOL OF MEDICINE DEPARTMENT OF DERMATOLOGY, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-9258

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-03575
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8102742
NC
Enumeration date
08/10/2012
Last updated
12/04/2012
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