Individual provider · NPI-1

Amber Jane Van Sickle-Birch, PMHNP

Nurse Practitioner, Psych/Mental Health · Idaho Falls, ID

NPI number1831716604
StatusActive
Last updated in NPPESSep 6, 2022

Details

NPI
1831716604
Entity type
Individual (NPI-1)
Name
Amber Jane Van Sickle-Birch
Credential
PMHNP
Sex
Female
Sole proprietor
Yes
Enumeration date
Jun 28, 2020
Certification date
Sep 6, 2022
Last updated
Sep 6, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0808X Nurse Practitioner, Psych/Mental Health70572IDYes
163WP0809X Registered Nurse, Psych/Mental Health, Adult43554ID

Practice location

1500 Pancheri Dr Ste 4
Idaho Falls, ID 83402-3212

Phone 208-579-6087 · Fax 888-519-8898

Mailing address

1500 Pancheri Dr Ste 4
Idaho Falls, ID 83402-3212

Phone 208-579-6087 · Fax 888-519-8898

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