Individual
KATHLEEN D AMBROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
64580 VAN DYKE RD, SUITE C, WASHINGTON, MI 48095-2857
(586) 752-9629
(586) 752-4099
Mailing address
64580 VAN DYKE RD, STE C, WASHINGTON TOWNSHIP, MI 48095-2811
(586) 226-6865
(586) 226-6880
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
470413564
MI
363LF0000X
Family Nurse Practitioner
Primary
4704131564
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4378376
—
MD
01
—
50-0866503-0
BCBS PIN NUMBER
MI
Enumeration date
03/25/2006
Last updated
02/01/2017
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