Individual
NANCY DIANE AMBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3770 GLENKERRY CT, PORTAGE, MI 49024-0700
(269) 329-2887
(269) 329-2805
Mailing address
61 COMMERCE AVE SW, GRAND RAPIDS, MI 49503-4124
(616) 940-0660
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704151927
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4504130
MEDICAID
MI
05
—
4504140
—
MI
01
—
4544234
MEDICAID
MI
Enumeration date
04/27/2006
Last updated
11/19/2008
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