Provider Demographics
NPI:1699578633
Name:AMBROSE, OMAR KAHILIL
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:KAHILIL
Last Name:AMBROSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14830 OLD CHENEY RD
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NE
Mailing Address - Zip Code:68461-9662
Mailing Address - Country:US
Mailing Address - Phone:614-946-6855
Mailing Address - Fax:
Practice Address - Street 1:2600 S 70TH ST APT 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2905
Practice Address - Country:US
Practice Address - Phone:614-946-6855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker