Healthcare Provider Details

I. General information

NPI: 1508760778
Provider Name (Legal Business Name): AMBROSE PSYCHIATRY & WELLNESS, PS.INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 MAIN ST
FERNDALE WA
98248-9468
US

IV. Provider business mailing address

6905 EDIN FARMS LN
LYNDEN WA
98264-9240
US

V. Phone/Fax

Practice location:
  • Phone: 360-220-6636
  • Fax:
Mailing address:
  • Phone: 360-220-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. AMANDEEP KAUR BENIPAL
Title or Position: PRESIDENT/OWNER
Credential: ARNP PMHNP-BC
Phone: 360-220-6636