Basic Information
| Provider Information | |||||||||
| NPI: | 1598232639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CEPULEVICIUS | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7400 NIGHTINGALE DR APT 12 | ||||||||
| Address2: | |||||||||
| City: | HOLLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435288207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7748129170 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3800 RESERVOIR RD NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200072113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024448640 | ||||||||
| FaxNumber: | 2024448854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2018 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN1051263 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | RN.427075 | 01 | OH | REGISTERED NURSE | OTHER |