Provider Demographics
NPI:1558722876
Name:LENNON, AMBER ROSE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ROSE
Last Name:LENNON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:126 E 12TH ST
Mailing Address - Street 2:APT 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5326
Mailing Address - Country:US
Mailing Address - Phone:609-313-4022
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:SUITE M 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307391363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD3698581OtherDEA