Healthcare Provider Details

I. General information

NPI: 1376810366
Provider Name (Legal Business Name): DONNA MARIE AMBROSE MSN, RN, CARN-AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422
US

IV. Provider business mailing address

15107 INTERLACHEN DRIVE APT 210
SILVER SPRING MD
20906
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax:
Mailing address:
  • Phone: 202-745-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN196822L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: