Provider Demographics
NPI:1366411340
Name:AMBROSE, LINDA L (CNP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:L
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 WALL ST
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011-8455
Mailing Address - Country:US
Mailing Address - Phone:740-625-5641
Mailing Address - Fax:
Practice Address - Street 1:444 N CLEVELAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8387
Practice Address - Country:US
Practice Address - Phone:614-899-2700
Practice Address - Fax:614-823-5656
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06549363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00148106OtherRR MEDICARE
OH000000365407OtherANTHEM PIN NUMBER
OH2477412Medicaid
OHP00148106OtherRR MEDICARE
OHNP14542Medicare ID - Type Unspecified