Provider Demographics
NPI:1942649363
Name:AMBROSE, CHANDRA N (APRN)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:N
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 BELLE CHASSE HWY
Mailing Address - Street 2:B-2
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7156
Mailing Address - Country:US
Mailing Address - Phone:504-349-2273
Mailing Address - Fax:504-349-6160
Practice Address - Street 1:2600 BELLE CHASSE HWY
Practice Address - Street 2:B-2
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-349-2273
Practice Address - Fax:504-349-6160
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP06796OtherAPRN
LA2342029Medicaid
LA300900YJDXMedicare PIN