Provider Demographics
NPI:1841737939
Name:CHE AMBE, IMMACULATE (CRNA)
Entity Type:Individual
Prefix:
First Name:IMMACULATE
Middle Name:
Last Name:CHE AMBE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 265
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4724
Mailing Address - Country:US
Mailing Address - Phone:804-594-2622
Mailing Address - Fax:804-594-0915
Practice Address - Street 1:10800 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 265
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4724
Practice Address - Country:US
Practice Address - Phone:804-594-2622
Practice Address - Fax:804-594-0915
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174540367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered