Individual
BRANDI AMBROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HAIR LOSS SPT
Contact information
Practice address
3408 W 95TH ST, EVERGREEN PK, IL 60805-2204
(773) 621-1199
Mailing address
2640 E MARTHA PL, CHICAGO, IL 60633-2092
(773) 899-8561
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
04/21/2020
Last updated
04/21/2020
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