Healthcare Provider Details

I. General information

NPI: 1881144715
Provider Name (Legal Business Name): JESSAMYN R AMBLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSAMYN R SALTER

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR SUITE 0860
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-8620
  • Fax: 317-944-8080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71006594A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: