Provider Demographics
NPI:1407099963
Name:AMBERSLEY, MICHELLE FLORENCE (RN,BSN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:FLORENCE
Last Name:AMBERSLEY
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75TH MEDICAL COMPANY AREA SUPPORT
Mailing Address - Street 2:UNIT#15190 BOX#13
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75TH MEDICAL COMPANY AREA SUPPORT
Practice Address - Street 2:UNIT#15190 BOX#13
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271-5228
Practice Address - Country:US
Practice Address - Phone:317-753-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0081379163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health