MEDICARE: MARY ANN AMBROSE MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP12654	CA
2	163W00000X	Registered Nurse	RN094333	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00011916	OTHER	CA	MEDICARE RAILROAD CARRIER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811993991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN AMBROSE MSN, FNP-C

Provider Business Mailing Address
First Line	:	145 SHADOW CREEK LN
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-1922
Country	:	US
Telephone Number	:	805-748-5663
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 SHADOW CREEK LN
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-1922
Country	:	US
Telephone Number	:	805-748-5663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	08/28/2012

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