Provider Demographics
NPI:1326382466
Name:AMBROSE, PAIGE S (NP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:S
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:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-7246
Mailing Address - Fax:812-450-4855
Practice Address - Street 1:4600 W LLOYD EXPY
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6517
Practice Address - Country:US
Practice Address - Phone:812-450-7246
Practice Address - Fax:812-450-4855
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004215A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily