Provider Demographics
NPI:1043579063
Name:AMBUS, TONIA DENISE
Entity Type:Individual
Prefix:MS
First Name:TONIA
Middle Name:DENISE
Last Name:AMBUS
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 1:10262 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1322
Mailing Address - Country:US
Mailing Address - Phone:314-395-9655
Mailing Address - Fax:314-395-8655
Practice Address - Street 1:10262 PAGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1322
Practice Address - Country:US
Practice Address - Phone:314-395-9655
Practice Address - Fax:314-395-8655
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO171W00000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist