Provider Demographics
NPI:1568603611
Name:EARLE, AMBROSE B JR (MA)
Entity Type:Individual
Prefix:MR
First Name:AMBROSE
Middle Name:B
Last Name:EARLE
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N 9TH ST
Mailing Address - Street 2:#8
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-7685
Mailing Address - Country:US
Mailing Address - Phone:515-989-6008
Mailing Address - Fax:515-989-6008
Practice Address - Street 1:630 N 9TH ST
Practice Address - Street 2:#8
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-7685
Practice Address - Country:US
Practice Address - Phone:515-989-6008
Practice Address - Fax:515-989-6008
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide