Provider Demographics
NPI:1760750780
Name:AMBROSE, MARGIE KAY (CHP)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:KAY
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:HUSLIA
Mailing Address - State:AK
Mailing Address - Zip Code:99746-0090
Mailing Address - Country:US
Mailing Address - Phone:907-829-2283
Mailing Address - Fax:907-829-2203
Practice Address - Street 1:166 SPRING CAMP ROAD
Practice Address - Street 2:
Practice Address - City:HUSLIA
Practice Address - State:AK
Practice Address - Zip Code:99746
Practice Address - Country:US
Practice Address - Phone:907-829-2283
Practice Address - Fax:907-829-2203
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker