Provider Demographics
NPI:1154002608
Name:AMBURGEY, ALISON JOYCE (PMHNP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:JOYCE
Last Name:AMBURGEY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:JOYCE
Other - Last Name:AMBURGEY-DAHLBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:245 FIELDING ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2431
Mailing Address - Country:US
Mailing Address - Phone:248-568-8267
Mailing Address - Fax:
Practice Address - Street 1:245 FIELDING ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2431
Practice Address - Country:US
Practice Address - Phone:248-568-8267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273861363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health