Healthcare Provider Details

I. General information

NPI: 1538759543
Provider Name (Legal Business Name): AMBROSE INJURY AND WELLNESS, A NURSING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GREEN VALLEY RD
EL DORADO HILLS CA
95762-3927
US

IV. Provider business mailing address

350 GREEN VALLEY RD
EL DORADO HILLS CA
95762-3927
US

V. Phone/Fax

Practice location:
  • Phone: 916-933-6700
  • Fax: 916-933-2253
Mailing address:
  • Phone: 916-933-6700
  • Fax: 916-933-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH ROY AMBROSE
Title or Position: PRES
Credential: DC, MSN-FNP
Phone: 916-933-6700