Healthcare Provider Details

I. General information

NPI: 1033359252
Provider Name (Legal Business Name): SHIREEN A. AMBERSLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

007 CHOOSGAI DRIVE
TOHATCHI NM
87325
US

IV. Provider business mailing address

14300 STATLER BLVD APT 617
FORT WORTH TX
76155-2843
US

V. Phone/Fax

Practice location:
  • Phone: 505-733-8400
  • Fax: 817-545-7988
Mailing address:
  • Phone: 845-430-5178
  • Fax: 817-545-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: