Provider Demographics
NPI:1275863441
Name:AMBA, KATHERYNE TIFUH (NP)
Entity Type:Individual
Prefix:
First Name:KATHERYNE
Middle Name:TIFUH
Last Name:AMBA
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:100 NORTH ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-214-5681
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:999 EXECUTIVE PARKWAY DR STE 210
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6336
Practice Address - Country:US
Practice Address - Phone:314-514-6005
Practice Address - Fax:866-497-1239
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2018-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2009038527363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care