Provider Demographics
NPI:1982184883
Name:AMBROSE, MICHELLE AUDREY SUSAN (NP-F)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:AUDREY SUSAN
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:NP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 CORNWALL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3719
Mailing Address - Country:CA
Mailing Address - Phone:360-734-2330
Mailing Address - Fax:360-733-3886
Practice Address - Street 1:9-47042 MACFARLANE PLACE
Practice Address - Street 2:
Practice Address - City:CHILLIWACK
Practice Address - State:BRITISH COLUMBIA
Practice Address - Zip Code:V2R0P3
Practice Address - Country:CA
Practice Address - Phone:778-866-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60865042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily