Provider Demographics
NPI:1326288606
Name:AMBROSE, CELYNNE FLEUR (NP)
Entity Type:Individual
Prefix:
First Name:CELYNNE
Middle Name:FLEUR
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL ROAD
Mailing Address - Street 2:LAHEY CLINIC, INC.
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805
Mailing Address - Country:US
Mailing Address - Phone:781-744-8834
Mailing Address - Fax:781-744-5253
Practice Address - Street 1:41 MALL ROAD
Practice Address - Street 2:LAHEY CLINIC, INC.
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805
Practice Address - Country:US
Practice Address - Phone:781-744-8834
Practice Address - Fax:781-744-5253
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN272817363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084944AMedicaid
MA001530801Medicare PIN