Provider Demographics
NPI:1497483382
Name:AMBROSE, OLIVIA JEANINE (PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JEANINE
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 NC HIGHWAY 305
Mailing Address - Street 2:
Mailing Address - City:AULANDER
Mailing Address - State:NC
Mailing Address - Zip Code:27805-9662
Mailing Address - Country:US
Mailing Address - Phone:252-642-5240
Mailing Address - Fax:
Practice Address - Street 1:1154 NC HIGHWAY 305
Practice Address - Street 2:
Practice Address - City:AULANDER
Practice Address - State:NC
Practice Address - Zip Code:27805-9662
Practice Address - Country:US
Practice Address - Phone:252-642-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32433662172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver