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General NPI Number Information
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NPI Number | 1073039376
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Entity Type | Individual
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Provider Name | AMBRIA REPASS APN
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Gender | Female
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 126 E MAIN PLZ
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2745
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Country | US
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Telephone | 210-223-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 13900 LAKE SONG LN UNIT S4
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City | BROOMFIELD
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State | CO
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Zip | 80023-6555
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Country | US
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Telephone | 309-945-8019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APN.0993251
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License Number State | CO
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