Provider Demographics
NPI:1356659601
Name:AMBLE, KARLA JEAN
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:JEAN
Last Name:AMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6054 COUNTY ROAD Z
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588-9022
Mailing Address - Country:US
Mailing Address - Phone:608-588-3131
Mailing Address - Fax:
Practice Address - Street 1:6054 COUNTY ROAD Z
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588-9022
Practice Address - Country:US
Practice Address - Phone:608-588-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173892-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse