Doctor Name: | DR. MICHELLE DAWN AMBROSE |
NPI Number: | 1578583761 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | PSY002453 |
Business Practice Address: | 701 Hospital Loop Fairchild Afb, WA - 990118704 |
Business Phone Number: | 5092478938 |
Business Fax Number: | |
Mailing Address: | 701 Hospital Loop, FAIRCHILD AFB |
State: | WA |
Postal Code: | 990118704 |
Phone Number: | 5092478938 |
Fax Number: | |
NPI Enumeration Date: | 07/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY002453 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |