Individual
MANDI GLYNN AMBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10227
MN
363AS0400X
Surgical Physician Assistant
Primary
PA04670
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
517690000
—
MN
01
—
8N9216
BLUE CROSS
TX
01
—
P00408065
RAILROAD MEDICARE
MN
Enumeration date
09/06/2006
Last updated
01/26/2022
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