Provider Demographics
NPI:1932368362
Name:AMBROSE, MARIA DICENSO (CPNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DICENSO
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:PLASTIC SURGERY DEPT. HUNNEWELL ONE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6919
Mailing Address - Fax:617-738-1657
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:PLASTIC SURGERY DEPT. HUNNEWELL ONE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6919
Practice Address - Fax:617-738-1657
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA256546363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics