Individual
AMBER MODDRELL
Active
Individual
AMBER MODDRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26-3162747
TUTOR
—
Enumeration date
01/04/2012
Last updated
01/04/2012
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