Provider Demographics
NPI:1508698465
Name:NDI, CLARISE AMBUN
Entity type:Individual
Prefix:
First Name:CLARISE
Middle Name:AMBUN
Last Name:NDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARISE
Other - Middle Name:AMBUN
Other - Last Name:NDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7705 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3958
Mailing Address - Country:US
Mailing Address - Phone:240-988-9358
Mailing Address - Fax:
Practice Address - Street 1:7705 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3958
Practice Address - Country:US
Practice Address - Phone:240-988-9358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator