Provider Demographics
NPI:1316465958
Name:ADERSON, AMBIANCE (CRNP)
Entity type:Individual
Prefix:
First Name:AMBIANCE
Middle Name:
Last Name:ADERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMBIANCE
Other - Middle Name:
Other - Last Name:MUNNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 GREENE ST APT 515
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144
Mailing Address - Country:US
Mailing Address - Phone:786-423-2855
Mailing Address - Fax:
Practice Address - Street 1:127 N. BROAD ST.
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-845-5344
Practice Address - Fax:856-537-7686
Is Sole Proprietor?:No
Enumeration Date:2017-09-04
Last Update Date:2017-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017206363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care