Individual
MR. BRANDON AMBROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
3 KENSINGTON SQ # A, NEW KENSINGTON, PA 15068-6443
(878) 847-7179
Mailing address
3 KENSINGTON SQ # A, NEW KENSINGTON, PA 15068-6443
(878) 847-7179
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN627220
PA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP022299
PA
Other
Enumeration date
07/17/2020
Last updated
11/11/2020
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