Basic Information
| Provider Information | |||||||||
| NPI: | 1639809528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHEBUS | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | REANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5695 E VALLEYVIEW PT | ||||||||
| Address2: | |||||||||
| City: | BRINGHURST | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469139441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654187477 | ||||||||
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| Practice Location | |||||||||
| Address1: | 833 PARK EAST BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479050785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657434400 | ||||||||
| FaxNumber: | 7657434411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2022 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 28176781A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.