Healthcare Provider Details

I. General information

NPI: 1811208754
Provider Name (Legal Business Name): DAWNE AMBROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E 101ST ST
BROOKLYN NY
11236-5507
US

IV. Provider business mailing address

1401 E 101ST ST
BROOKLYN NY
11236-5507
US

V. Phone/Fax

Practice location:
  • Phone: 718-241-3715
  • Fax:
Mailing address:
  • Phone: 718-241-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number428608
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: