Provider Demographics
NPI:1659971745
Name:AMBROSE, CHRISTINA JOHANNA (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOHANNA
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3779 HUNTMERE AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3144
Mailing Address - Country:US
Mailing Address - Phone:330-318-2715
Mailing Address - Fax:
Practice Address - Street 1:3779 HUNTMERE AVE
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3144
Practice Address - Country:US
Practice Address - Phone:330-318-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.170858.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse