Healthcare Provider Details

I. General information

NPI: 1174866057
Provider Name (Legal Business Name): SARAH JANE AMBROSE CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3876 BRIDGE WAY N STE 300
SEATTLE WA
98103
US

IV. Provider business mailing address

3876 BRIDGE WAY N STE 300
SEATTLE WA
98103
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-6627
  • Fax: 206-525-5933
Mailing address:
  • Phone: 206-624-6627
  • Fax: 206-525-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW 60295161
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: