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Individual

MRS. JACQUELINE R AMBROSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, RD, ADCES

Contact information

Practice address
618 HOSPITAL RD, TAPPAHANNOCK, VA 22560-5000
(804) 443-6179
Mailing address
PO BOX 566, AYLETT, VA 23009-0566
(804) 314-0409

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
911825
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20810009
ASSOCIATION OF DIABETES CARE & EDUCATION SPECIALIST
Enumeration date
02/08/2020
Last updated
02/08/2020
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