Provider Demographics
NPI:1437492279
Name:AMBROSI, BETHANY MICHAELA (DO)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MICHAELA
Last Name:AMBROSI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MICHAELA
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1881 NANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1811
Mailing Address - Country:US
Mailing Address - Phone:808-871-7772
Mailing Address - Fax:808-872-4029
Practice Address - Street 1:1881 NANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1811
Practice Address - Country:US
Practice Address - Phone:808-871-7772
Practice Address - Fax:808-872-4029
Is Sole Proprietor?:No
Enumeration Date:2013-03-30
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO181047207V00000X
HIDOS2434207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2079492Medicaid
OR500724816Medicaid