Provider Demographics
NPI:1487081220
Name:AMBROSE, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SPRING CAMP ROAD
Mailing Address - Street 2:
Mailing Address - City:HUSLIA
Mailing Address - State:AK
Mailing Address - Zip Code:99746
Mailing Address - Country:US
Mailing Address - Phone:907-829-2281
Mailing Address - Fax:907-829-2203
Practice Address - Street 1:166 SPRING CAMP ROAD
Practice Address - Street 2:
Practice Address - City:HUSLIA
Practice Address - State:AK
Practice Address - Zip Code:99746
Practice Address - Country:US
Practice Address - Phone:907-829-2281
Practice Address - Fax:907-829-2203
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker