Individual
AMY IBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
1311 E MILLBROOK RD, RALEIGH, NC 27609-5473
(919) 719-0119
Mailing address
6700 EASTBROOK DR, RALEIGH, NC 27615-7309
(818) 489-7613
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15211
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-10839
LICENSE
NC
Enumeration date
08/12/2006
Last updated
03/07/2023
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