Healthcare Provider Details

I. General information

NPI: 1144325648
Provider Name (Legal Business Name): NAN L AMBROSY DNP, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAN AMBROSY DNP, ARNP

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SAINT FRANCIS DR
WATERLOO IA
50702-5644
US

IV. Provider business mailing address

2750 SAINT FRANCIS DR
WATERLOO IA
50702-5644
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8922
  • Fax:
Mailing address:
  • Phone: 319-272-8922
  • Fax: 319-272-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-74864
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number53-45383
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberT128919
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG128919
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: