=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144325648
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAN L AMBROSY DNP, ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 03/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2750 SAINT FRANCIS DR
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50702-5644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-272-8922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2750 SAINT FRANCIS DR
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50702-5644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-272-8922
-----------------------------------------------------
Fax | 319-272-8929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 53-74864
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 53-45383
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 364SP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | T128919
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | G128919
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------