Provider Demographics
NPI:1831978949
Name:D'AMBROSIO, DERNA (CRNP)
Entity type:Individual
Prefix:
First Name:DERNA
Middle Name:
Last Name:D'AMBROSIO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DERNA
Other - Middle Name:
Other - Last Name:GASPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2403 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-5302
Mailing Address - Country:US
Mailing Address - Phone:484-503-0600
Mailing Address - Fax:866-798-4183
Practice Address - Street 1:2403 BUTLER ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-5302
Practice Address - Country:US
Practice Address - Phone:484-503-0600
Practice Address - Fax:866-798-4183
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner